B-2017-0691CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
11700 REGNART CANYON DR CUPERTINO, CA
CONTRACTOR:
PERMIT NO: B-2017-0691
95014-4830 (366 33 ,002)
DE ANZA BUILDERS
CAMPBELL, CA 95008
OWNER'S NAME: ZHU JAMES J AND YE PING
DATE ISSUED: 05/02/2017
OWNER'S PHONE: 818-636-1520
PHONE NO: (408) 865-0222
LICE . NSED CONIRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #943227
Contractor DIE AN A BUILDERS Date 02/28/2018
X BLDG X ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— 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:
(N) TEMPORARY POWER POLE (100 AMPS)
i. 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
of the work for which this permit is issued.
z.J-performance
I have and will maintain Worker's Compensation Insurance, as provided for by
l Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $1500.00
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
36633002
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 agai s liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against s id ity in consequence of the granting of this permit.
Additionally, the appli an understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations pet Cupertino Municipal Code, Section 9.18,
180 DAYS FROM LAST CALLED INSPECTION.
.-Signature Date 5/2/2017
Issued by: AbbyAy-qnde
Date: 05/02/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
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 of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date:/25 /2017
I hereby affirm under penalty of perjury one of the following three declarations:
i. 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 stare or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipmen o devices which emit hazardous
'
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area uality Management District I
will maintain compliance with the Cupertin M cipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Section 25 5, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. ,
Owner or authorized agent:
APPLICANT CERTIFICATIONC, 'Date:
5/2/2017
I certify that I have read this application and state that the above information is
rION LEADING 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 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.
Signature Date 5/2/2017
Licensed
Professional
CUPERTINO
�- X 1¢t - U(914J
GENERAL PERMIT APPLICATIONMFW
COMMUNITY QEVELOPMENT DEPARTMENT • t3UJLDING DIVISION
10300 TORRE AVENUE • CU,PERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildina(a�cuPertino.org -MISC
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❑ OwNER ❑ OwNER-BUII.DER ❑ O,VNERAGENT CONTRACTOR ❑ CONTRACTORAGLT*r ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
COIN'TRACTOR-I j_ � LICENSE NUMBER 2 Z, LICENSE TYPE
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USE OF k't SFD.-, DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑COMMERCIAL
PROTECT INT 7tLAND ❑ "YES
URBAN INTERFACE AREA ❑ NO
PROTECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ 17ES
EICHLERHOME? ❑ NO
DESCRIPTION OF WORK p
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TOTAL VALUATION: p
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RECEIVEDBI
By my signature below, I certify to each of the follow a: am the property owner or authorized agent to act on the property ow er's behalf. I have read this
application and the information I have provided is or, ct. have read the Description of Wark and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c tru io . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: z" 1
SUP PLE#ENTA14V INFORMATION REQUIRED
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AfEPMiscApp_2011.doc revised 05/21111