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B-2016-2941 CITY OF CUPERTINO BUILDING PERMIT • BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2941 22347 STEVENS CREEK BLVD CUPERTINO,CA 95014-1057(326 50 010) HOMEOWNER BUILDER ' OWNER'S NAME: YANG YINGCHUN AND HE JIANSHE . DATE ISSUED:05/04/2017 OWNER'S PHONE:408-480-7342 PHONE NO: . LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor HOMEOWNER BUILDER Date X BLDG _ELECT _PLUMB 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: ADD(N)FRONT PORCH(48 SF);REMODEL BATH(62 SF); I hereby affirm under penalty of perjury one of the following two declarations: REMODEL KITCHEN(153 SF);REPAIR 2ND FLOOR DECK(805.5 1. I have and will maintain a certificate of consent to self-insure for Worker's SF); Compensation,as provided for by Section 3700 of the Labor Code,for the RE-STUCCO(100 SF)FRONT FACADE performance of the work for which this permit is issued. REV#1-REMOVE DECK FROM 2ND FLOOR AND REPLACE WITH ' 2. I have and will maintain Worker's Compensation Insurance,as provided for by AWNING;CUT BACK(E)CANOPY-ISSUED 8/23/2017 . Section 3700 of the Labor Code,for the performance of the work for which this REV#2-EXTERIOR RSTUCCO(100;S.F.);REPLACE WINDOWS(10)- permit is issued. LIKE FOR LIKE TO MEET EGRESS;ISSUED 10/4/2017 APPLICANT CERTIFICATION Sq.Ft Floor Area: 'Valuation:$50000.00 I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize APN Number: Occupancy Type: representatives of this city to enter upon the above mentioned property for 326 50 010 inspection purposes. (We)agree to save indemnify and keep harmless the, City of Cupertino against liabilities,judgments,costs,and expenses which mayd accrue againstsaidCityn in stands and e of the hg othis PERMIT EXPIRES IF WORK IS NOT STARTED Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR • 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10/4/2017 Issued by:ABBY AYENDE OWNER-BUILDER DECLARATION Date:05/04/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: 1. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for / ale(Sec.7044,Business&Professions Code) inspection. I,as owner of the property,am exclusively contracting with licensed i' contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 10/4/2017 u. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t formance of the work for which this permit is issued. i. `I ave and will maintain Worker's Compensation Insurance,as provided for by i Section 3700 of the Labor Code,3.— for the performance of the work for which this I have read the'hazardous HAZARDOUS materialsMATERIArequirements LSDISCLOunder SChapter 6.95 of the permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will 3. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health&Safety Code,Section 25532(a)should I store or handle hazardous Worker's Compensation laws of California. If,after making this certificate of material. Additionally,should I use equipment or devices which emit hazardous exemption,I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code,I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and be deemed revoked. / I the Health&Safet Cod:,Sec'ons'25 5 25533,and 534. APPLICANT CERTIFICATION �� �' 1:o ner or authorized agent: I certify that I have read this application and state that the above information is Date:10/4/2017 correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We)agree ,of work's for which this permit is issued(Sec.3097,Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ,Address ' ' and will comply with all non-point source regulations per the Cupertino Municipal Code,Secti•n 9.18/ - ARCHITECT'S DECLARATION I understand my plans shall be used as public records. NOatur• -- Date 10/4/2017 Licensed - CONSTRUCTION PERMIT APPLICATION \ ` COMMUNITY DEVELOPMENT DEPARTMENT •'BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 wyY;,°Ss • (408)777-3228 • building@cupertino.org PEMIT#B-2 6.I 6 - 2.. y'1 CUPERTINO REV# DEF# ❑NEW CONSTRUCTION ❑ADDITION;Igl ALTERATION ❑T.I, ❑MEP ,^❑RE-ROOF ❑SWIMMING POOL/SPA PROIPCT ADDRESS 2.2_22 ` '7 �� cjr Cr ( .t ( 1 " '32.6 5 n ,,,_' �} ` a OWNER NAME +� / !! II PHONE 'J E-MAIL ` I hnn )iaktche -i(a.,A.,,„.eukpl STREET ADDRESS Q CITY, STATE,ZIP GLl�vl e S rib} t�(OE [J CONTRACTOR NAME ,OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE STREET ADDRESS CITY,STATE,ZIP S'U,wl e a.s p ry j cei- A0(�� . E-MAIL PHONE BUS,LIC# ❑ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER❑DEVELOPER 0 TENANT CONTACT NAME E-MAIL.r` �'.. Lit, -- 6]„ ��r U k ©'A Q 2 (/� xV /� ft„' ' 11C�G 7�( c, C��.PHONE (�r(A-- STREET ADDRESS ).5 1 T Q l' U kr t.�. Q-D. CITY,STATE,IIPU 1.Z•- \t .6 1 QA /Qui t'� PI I6z- 5- ,N 7 DE PTON ''yU' 4p �tR U E (G -o P�T - D t=-( ts(z. 0,(�C is r pv 6> (�Lika- leitT& ( to ) Nt4Ntp6? . 2., .. CU— 'P S. C' CAs o L\-- , e01/ cem )_ 9 e0. �w►: rcxte i'or l o k, A. 2x a mecc a caH' W l n a�ws o W ark l*INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A 'TOTAL NET SF USE, , TYPE. OCC SQ,PT. ' VALUATION($) 1 I EMODEI. - REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED ' BATHROOM 5F `'••••• SF r SP .— SF•' ' ❑DETACHED r BXISING 0 YES EICHLER ❑YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS,�NO :j NO LNO DWELLING SECOND DWELLING ❑YES 0 ATTACHED 1:1 DETACHED I OTHER UNITS AIUNrTADDION: 0N SF POOLS` []FIBERGLASS 0 VINYL-LINED ❑GUNITE ❑PREFABRICATED POOL-SP SPA-SF 1 SPA ATTACHED-OWLS t•A NO 1 TOTAL-SF RECEIVED BY: TOTAL Vr1LUATION: Commack!or Mufti-Fmuily Buildings ioRir Pu6!!c Swimming Fools readres bcnnrtee;?of Envtrnnnrcntn!Heat maroon; �, ` RE-ROOF EXISTING ROOF TYPE: 0 BUILT-UP ROOF❑ASPHALT SHINGLES':WOOD SHAKES❑WOOD SHINGL ❑TIL OTHER(SPECIFY): REMOVE/REPLACE❑NO IF NO PLYWOOD 0 1/2" ❑3/E" PLYWOOD TYPE: ROOFCLASS ElyEs A OF LAYERS THICKNESS❑5/8" OTHER ❑OSE ❑CDX, OTHER :12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES['WOOD SHINGLES 0 OTHER _ *Provide a signed copy of the Cupertino's Tear-Off PolicySF Eat SQUARES • By-my signature below I certify to each of the following: I am the property owner or authorized agent to act on 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 with all applicable local ordinances an• state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for it •e •io purp..es. I acknowlee• and authorize all'information cpntained on this application form to be made available for public record. ` Signature of Applicant/Agent: - -, -.•••• - _ 1� Date: ig I 7,0i-T- SUPPLEMENTAL INFORMATION REQUIRED . *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of-this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit applicatiot. *HOA-Provide a letter of approval from the Horne Owner's Association • BidgApp_2017doe revised 08/01/17 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: I CONTRACTOR: PERMIT NO: B-2016-2941 22347 STEVENS CREEK BLVD CUPERTINO, CA 95014-1057 (326 50 010) HOMEOWNER BUILDER OWNER'S NAME: YANG YINGCHUN AND HE MANSHE OWNER'S PHONE: 408-480-7342 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor HOMEOWNER BUILDER Date I hereby affirm that 1 ani 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. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. z. 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. DATE ISSUED: 05/04/2017 PHONE NO: BUILDING PERMIT INFO: X BLDG _ ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: ADD (N) FRONT PORCH (48 SF); REMODEL BATH (62 SF); REMODEL KITCHEN (153 SF); REPAIR 2ND FLOOR DECK (805.5 SF); RE -STUCCO (100 SF) FRONT FACADE REV #1 - REMOVE DECK FROM 2ND FLOOR AND REPLACE WITH AWNING; CUT BACK (E) CANOPY - ISSUED 8/23/2017 Sq. Ft Floor Area: I Valuation: $50000.00 APN Number: Occupancy Type: 326 50 010 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 8/23/2017 Issued by: ABBY AYENDE Date: 05/04/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the propert}' am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: m. 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 �r performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the'grantirigof this permit. Additionally, the applicant understands and will comply with all on -point source regulations per the Cupertino Municipal Code, S Date 8/23/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed., If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 8/23/2017 11 A it HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 4�.-- the Health & Safety Cod , Sectio 25505, 3, and 25534. I or.authorized agent: Date: 8/23/2017 I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed. Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-325512 q /� (408) 777-3228 • building@cupertino.or PEMIT #B - _ 6 CUPERTINO REV#DEF# ❑ NEW CONSTRUCTION ❑ ADDITION X ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS ^ ^ f f S /' n n (c ( 'PtlHOJNs-Ef-\ APN # '5 Q OWNER NAME V Vo H J � 4-0_To> E-MAIL \Ia seee wm STREET ADDRESS CITY, STATE, ZIP Gl.� �z.wc e. � rCONTRACTOR NAME OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE STREET ADDRESS s nL / w e a� qro j A /VMl"Nl• / e U CITY, STATE, ZIP E-MAIL PHONE BUS. LIC # ❑ ARCHTTECr ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT [:1 ENGINEER ❑ DEVELOPER ❑ TENANT r` Cy ', j N CONTACT NAME ts E-MAIL / U o� n Ld v „ ti'. � • l.+o � STREETADDRESS CITY, STATE, 7JP PH NE DE TON �L9 N SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) EXISTING USE EXISTING IF NEW FLOOR IF PORCH IF DECK IF DEMO IF STORIES I TOTAL NET IF EMODEL '1 REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED BATHROOM IF IF IF —r SF-� ❑ DETACHED EXLSING ❑ YES FIRE SPRINKLERS ANO EICHLER ❑ YES Ik NO SECOND STORY ADDTITON []YES ANO DWELLING SECOND DWELLING ❑ yFs ❑ ATTACHED❑ DETACHED OTHER UNITS # UNIT ADDITON: ❑ NO IF POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA - SF I SPA ATTACHED ❑ YES N NO I TOTAL - SF Commercial or Multi-Fmniln Buildinfs with Public Swimming Pools requires Department o(Environmental Heatha, proval 1 RECEIVED BY:NV`I� TOTAL VALUATION: RE -ROOF EXISTING ROOF'TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGL S ❑ TIL OTHER (SPECIFY) REMOVE /REPLACE ❑ NO IF NO I PLYWOOD ❑ '/V E13/811 PLYWOOD TYPE: PITCH: ROOF CLASS ElYES # OF LAYERS THICKNESS ❑ 5/8" OTHER ❑ OSB [:]CDX OTHER 12 A PROPOSED ROOF ;TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER *Provide a signed copy ofahe;Cupertino's Tear -Off Policy SF #of SQUARES By my signature below I certify to each of the following: I am the property owner or authorized agent to act on 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 with all applicable local ordinances state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for ' e,---- 'o perp ses. I ackn IEand authorize all information c ntamed on this application form to be made available for public record. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA -Provide a letter of approval from the Home Owner's Association B1dg,4pp_M7.d6c revised 08101/17 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2941 22347 STEVENS CREEK BLVD CUPERTINO, CA 95014-1057 (326 50 010) OWNER/BUILDER OWNER'S NAME: YANG YINGCHUN AND HE HANSHE OWNER'S PHONE: 408-480-7342 License Class Lic. # Contractor OWNER/BUILDER Date 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. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 05-4-2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for /// sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: r. 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 05-4-2017-2017 DATE ISSUED: 05/04/2017 PHONE NO: BUILDING PERMIT INFO: X BLDG _ ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: ADD (N) FRONT PORCH (48 SF); REMODEL BATH (62 SF); REMODEL KITCHEN (153 SF); REPAIR 2ND FLOOR DECK (805.5 SF); RE -STUCCO (100 SF) FRONT FACADE Sq. Ft Floor Area: I Valuation: $50000.00 APN Number: Occupancy Type: 326 50 010 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 05/04/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 05-4-2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, �Sections o25505, 25533, and 25534. 11_4 Owner or authorized agent:(�`"— c Date: 05-4-2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (40B) 777-322.8 - FAX (408) 777-3333. buIId1no6DguDert1n0.org ❑ NEW CONSTRUCTION ❑ ADDITION 13-4u(w—c;"--/7/ I .IILTtRAT10N1TI ❑ REVISION1DEFERRED CR1CiTXIA PFRLnT:H PROTECT ADDRESS zz3 az4r, 31Vdj eel g 32 - OWNER O\iR ER NAh4E PHONE E � �S_ �v- STREET .ADDRESS A CITY, STATE, ZIP J U ^ ,„r -A 6 G l'al FAX (�t'C/ RkME I PHONE E-KAJL STREET ADDRESS CITY, STATE, ZIP FAX ❑ O\"a ❑ OWNER -BUILDER © OWNERAGETT ❑ CONTRACTOR ❑Cm,''TRACTORAGERT ❑ ARCHITECT ❑ ENGAM'ER ❑ DE1cLOPr_ft ❑ TENANT CONTRACTOR NAMEI LICENSE NUMBER LICENSE TYPE BUS. LIC r I ` C61APAN7 N AME E41AIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGNTER NAME LICENSE KUMBER ! BI.'S. LIC k ! COMPANYNAME E-MAIL -- FAX —�— STREETADDRESS CITY, STATE, 71? 1 PHONE DESCRIPTION OF WORD. ..._ 7 �-•9-I (rY�� J'� /KJSV 1 �'C.X .tS�{� � S � � - i� �L � � 1T roa, - ST\)eco { " s. F-XMIA'G USE PROPOSED USE CO04M TYkSTORES ��yA�4pC) USE TYPE OCC. SQ.FT, VALUATION (S) E XISTG AREA I-(� 6 L NTW FLOOR a1tEEA f ) j J DEMO fREA %a v 1 -- EtATrIP.00M RENZELAREAf�o (SF KITCHEN REMODELAREA 2 OTHER RZVODELAREA PO,R(; DECKAREA 70T.ALDECK.PORCHARE.A GARAGEAREA; DETACH II__ldld YYOO ATTACH D\i'ELLL.'G L`!iITS: ISA SF -CO O L11'n' (]1'ES SECONDSTORY []YES 1t� BEAGADDED? []?.'0 ADDITION? ❑?,'0 PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF 1S THE BLDG An [} YES i, TOTAL V, LUATION, PLAA•NNGAPPL:: t]NO PLA.�.SN-Q_APPROVALLETTER EICHLERHOME? L] NO 7'� By my signature. below, I certify to each ofthe following; I ain the property owner or authorized agent to act en 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 with all applicable local ordinances and state laws relating to building construction. i v rize representatives o Cupertino to enter the abov�entified property f r inspection purposes. Signatureof Appli Agent: � � ' - �- Date: _ cU / t SUPPLEMENTAL INFOn4ATION REQUIRED ::..h. - .:PLA'\,CFIECI�TIPE_ _ :�:-4•» .. ;.ROUTINGSL.iP New SFD or Multifamily dwellings: Apply for demolition permit for O\ ER THE COLTER �� existing building s). Demolition permit is required prior to issuance of builom building g5 - F '' 3 - }' BLLLD3NCPL4'� RECTEn �, - permit for new ID 5. E1PRE5 1 xis % p N -GP - \' _Commercial Bldgs: Protide a completed Hazardous 1\4aterials Disclosure❑.;PLBLIC,R`ORkS i- ionn if any Hazardous lMaterials are being used as part of this project. v FIRE DEPT. Y ' _ Copy of Planning Approval Letter or Mecting with Planning prior to -'� T+LAJOR'- r�t submittal of Building Permit application. S4'\i"rAfi1i EtiERDIsTRICT},s B1dgApp_2011.doc revised 06/21111 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - build ing(a cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS2-2 S-�Qil erg CYe K IV APN 324 _- 7Q_O I � BP# p OWNER NAMEOWNER e H� ADDRESS 2-2-3 f cyju/ d DESCRIPTION OF WORK: hDD(N Ono Jr C eJAi0O(e( 64-� k K1_hA0JQ,1 ' Yt- kY 2 H W Peck —54vec o frvYl l a carie We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) ) 1� 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 13--2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. Y4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license bers on permits and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the t t value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. _JX6. I understand if I am considered an "employer" under state and federal law, I must register with the state and ederal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. *8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 a VX -9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb,ca.gov for more information about licensed contractors. L10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. -al 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y all applicable laws and requirements that govern Owner -Builders as well as employers. 1$12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the formation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners si natur Property Owner's Signature: Date: 20 f --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10