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B-2017-0555CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0555 7961 WOODLARK WAY CUPERTINO, CA 95014-4936 (362 03 022) LIU'S CONSTRUCTION SAN JOSE, CA 95122 OWNER'S NAME: MCCLOSKEY JAMES M AND EVA-MARIA R TRUSTEE DATE ISSUED: 06/01/2017 OWNER'S PHONE: 408-655-5441 PHONE NO: (408) 966-3782 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class EI FC:TRICAI LIC. #966503 X BLDG X PLUMB Contractor LIU'S CONSTRUCTION Date 10/31/2017 —ELECT X MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: KITCHEN REMODEL (140 S.F.); BATHROOM REMODEL (90 S.F.); I hereby affirm under penalty of perjury one of the following two declarations: INSTALL (N) TANKLESS WATER HEATER AND FURNACE t. I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Z_ Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $38000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 03 022 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will mply with all non-point source regulations per the-fu{�ertino Muni ' ode, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature a 6/1!2017 Issued by: Abby Aygnde Date: 06/01/2017 OWNER-BUILDE:;ECLARAATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) i. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date:/1/6 2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code,-Sections 25505 533 a 4. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent- gentAPPLICANT APPLICANTCERTIFICATION Date: 6/1/2017 i&NCY I certify that I have read this application and state that the above information is DING correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constrilction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/1/2017 Professional CONSTRUCTION PERMIT APPLICATION. COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTIN0 (408) 777-3228- FAX (408) 777-3333 - build ing(a)cupertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION [9 ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS b j v o D. � r' (^J bAPN q / DL rp•� r OWNER NAME P ONE i`�°$� 6SS-�$�,ur E-MAIL/$j", /$f"> �.S„ � �.-,�.�1. c�•�, STREETADDRESSy 't2 ��plvp� CITY, STATE, ZIP p FAX ve SVA -1 VAe CI 7 CONTACT NAME w PHO E-MAIL m A [ w +� (' C caKY�'" i i .Cr STREET ADDRESS ' $�a3 CITY, STATE ZIP SI L{ IJIy �I/1L - FAX ❑ OWNER ❑ OWNER-EUMDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENWNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 7 LICENSETYPE BUS. LIC# COMPANY NAME FINWL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEERNAME1 LICENSENUMBER L J BUS. LIC# COMPANY NAME r E-MAIL ) FAX STREET ADDS CITY STATE, ZIP PHONE DESCRIPTION F WORK RU -6t,46 C.A l C- �( V1eal„�C� '%Utcn�ltis5' rl'�.(.Q.. EXISTING USE 1I�r"J PROPOSED t1� CONS TYPE �V/ # STORIES USE TYPE OCC, SQ.FT. VALUATION (S) EXIST JFIJLI,l.tD� �7 NEW FLOORS.9F0 DEMO TOTAL AREA 1 AREA 17 2 AREA NET AREA BATHROOMKITCHEN OTHER REMODELAREA lqv REMODELAM REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCHAREAGARAOE A: DETACH ATTACH # DWELLING UNITS: ISA SECOND UNIT❑ SECOND STORY YES J BEING ADDED? O ADDITION? []NO PREAPPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES. RECEIVED BY, - TOT . L VALUATION: PLANNING APDL# []NO PLANNING APPROVA L LETTER EICHLERHGME? []NG lJl, V 1VY` � By my signature below, I certify to each of the following: I am the property owner or authorized agent act oh the property owner's behalf. I have read this application and the information I have provided is connect. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to build' construction. I authorize representatives of Cupertino to enter the above -identified propgrty for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED PLANCIIECKTYPE . Tt OUTING SLIP ❑ ovEli•TH>-CouprrER BUILDING PLAN IiwiEFv _ New SFD or Multifamily dwellings: Apply for demolition permit forr' existing building(s). Demolition permit is required prior to issuance of building pennit for new building. ❑ EXPRESS PLANNING PLAN REV1EWC01 1) _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAADARD ❑ PUBLIC WORKS form if any I-3azardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ T<'iAJOR SOWER Yr]STItICT submittal of Building Permit application, .��SANITARY ❑ ENVIRONA4ENTAL HEALTH B1dgApp_2011.doc revised 06121/11 llv' CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7961 WOODLARK WAY CUPERTINO, CA 95014-4936 (362 03 022) CONTRACTOR: LID'S CONSTRUCTION PERMIT NO: 2017-0555 ;k SAN JOSE, CA 95122 OWNER'S NAME: MCCLOSKEY JAMES M AND EVA -MARIA R TRUSTEE DATE ISSUED: 04/24/2017 OWNER'S PHONE: 408-655-5441 PHONE NO: (408) 966-3782 LJ-CENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: I License Class B/CA 0 Lic. #966503 I Contractor L IU'S CONSTRUCTION Date 10/31/2017 X BLDG _ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH X RESIDENTIAL _COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: KITCHEN REMODEL (140 S.F.); BATHROOM REMODEL (90 S.F.); 1. I have and will maintain a certificate of consent to self -insure for Worker's INSTALL (I) TANKLESS WATER HEATER AND FURNACE Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $38000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 03 022 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED i may accrue against said City in consequence of the granting this permit. Additionally, the applicant understands and willl comply with all ll non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations -per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 94/24/2017 Issued by: Date: 04/24/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for, compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property,'am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 04/24/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health &Safety Code, Section 25532(a) should I store or handle hazardous ; shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous' Worker's Compensation laws. of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and, exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 2553 34. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agenty/ APPLICANT CERTIFICATION Date: 04/24/2017 a/ I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance; relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property yfor inspection purposes. (We) agree Name i' to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands j and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 04/24/2017 Licensed Professional 03 CONSTRUCTION PERMIT APPLICATION, COMMUNITY DEVELOPMENT DEPARTMENT ■ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • building@cupertino.org CUi'EEtTINO I ❑ NEW CONSTRUCTION I _ I ADDITION I `11 AT.TF.R ATTnl4 / TT n uT71Trcrn-1T r T%T2 n nan - ----- -- BldgApp 2011, doc revised 06121/11 -----.V111 it PROJECT ADDRESS 6 �J ^ b o D r— wd-r APN # �I —0'3,—o�>>- OWNBRNAME pjj >'T{UrVl� E MAII P ONE lt�q�� jss"IilFr fffAnn �r �+1, ( 11dr1� Cn+h STREETADDRESS �7 2 �t( tvAry� /ive r CITY, STATE,, ZIP p Svnn .�a12 Ce ILf�v�% FAX CONTACT NAME ' -A PHO &MAIL AIGne'1es�^�¢? rilAi , (A h STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-nUEDER ❑ OWNERAOENT ❑ CONTRACTOR ❑ CONTRACTORAGENT Q ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME i f� /' [ CA d (/ LICENSE NUMEEI&p ((JJ`� LICENSE TYPE a BUS. LIC # � �r- COMPANYNAME �( f /` �� G (� B MAIL i FAX STREET ADDRESS %C, �Y�l�CITY, STATE, ZIP52 `,q /y ( PHONE j f®� / ((' %%_3 7 -� fj (�f ARCHITECT/ENGINEER NAME CLAP %l1:11,16J LICENSE NUMBER S r ,5 _ BUS, LICG#Y COMPANY NAME�� E-MAIL FAX STREET ADD SS .32 CITY STATE, ZIP PHONE DESCRIPTION 7 WORK - i Yvt/1-1Lf ZW V cs,� 'A-A"LL9— EXISTING USE PROP U$E CON3TIy� TYPE `V! # STORIES 'USE TYPE _ OCC. !k�T'•'J SQ.FT. VALUATION ($) EXIST JAtGI+ AREA, NEW FLOOR AREA.�11 DEMO AREA TOTAL NETAREA ,�,3 BATHROOM KITCHEN REMODEL AREA �/� REMODEL A #0, OTHER REMODEL AREA PORCHAREA DECKAREA TOTALDECKIPORCH AREA GARAGE A: ❑DETACH ❑ ATTACH I #DWELLiNGUNrrs: i ISA SECOND UNIT❑ BEINGADDED7 ^ p SBCONDSTORY ©YES ADDITION? ❑NO PR&APPLICATIO(N []YES IFYES,PROVIDECOPY OF PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER ISTIIEDLUGAN El YES. EICHLERHOME7 El NO RECEIVLD:BX' . TOTAL VALUATION: By my signature below, I certify to each of (lie following: I am the property owner or authorized agent Yo act oh the property owner's behalf. I Have read this application and the information I have provided is correct, I have read the Description of Work and verify it is accurate. I agree to comply withal] applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-iddeLntifed prop V for inspection purposes. Signature of Applieant/Agent: }I u+l Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN crlEClsrrPl .. IioDTJNc SLIP ❑ OykR-THE-COUNTF,R BUILDING PLAN REM111 _ New SFD or Multifamily, dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS r _j .�FLANNINGPLAN itEvtEll'� _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS Torn if any hazardous Materials are being used as part oftliis project, 13 LARGE ❑ rHtF DEPT _ Copy of Planning Approval Letter or Meeting with Plalming prior to ❑ -A-WOR submittal of Building Permit application. .la'SANITARYSrWFRDISTRICT ❑ I NvI ONNMNTAL REALTH BldgApp 2011, doc revised 06121/11