B-2017-0760CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0760
20883 SOLA ST CUPERTINO, CA 95014-2926 (359 13 056)
W S CONSTRUCTION
CO
DALY CITY, CA 94014
OWNER'S NAME: LIN CHEN-HSI AND WANG JOE -SUE TRUSTEE
DATE ISSUED: 05/12/2017
OWNER'S PHONE: 408-886-8412
PHONE NO: (415) 279-1893
LICENSED D ONT A TOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 13 Lic. #840091
Contractor W S CONSTRUCTION CO Date 06/30/2018
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:
KITCHEN REMODEL - (150 SF)
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.
i. 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
Sq. Ft Floor Area:
Valuation: $4000.00
r V permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
359 13 056
359
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue ag inst said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, th applicant understands and will comply with all non -point
source regulati ns per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/12/2017
Issued by: Kim Dunbar
CLARATION
Date: 05/12/2017
OWNER -BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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)
i. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Scc.7044, Business & Professions Code).
Date: 05/12/2017
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
Health &Safety Code, Section 2 32(a) should I store or handle hazardous
material. Additionally, should I use quipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the ay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the pertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
t.
be deemed revoked.Owner
or authorized agent:'ZAA
APPLICANT CERTIFICATION
Date: 05/12/2017
ZENDING
I certify that I have read this application and state that the above information is
N AGENCY
affirm that there is a construction lending agency for the performance
I hereby a
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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'SDECLARATION
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 05/12/2017
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 • building Qcupertino.org�r�C-+ , -:�-/ 0
I 111MAV r0VT TPI TrTTON I I ADTI TToN I-1 AT.TF.R ATTON / Ti I—I REVISION / DEFERRED ORIGINAL PERMIT #
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d3 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ' , 1� J
LICENSE NUMBER
LICENSE TYPE
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COMPANY NAME
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Crs v 1�
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
[]ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? [:]NO
ADDITION? ❑NO
PRE -APPLICATION []YES IF YES, PROVID COPY OF
IS THE BLDG AN ❑ YES
Y:-:
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APP VAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each o 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 pro ided is correct. I have read the Description of Work and verify it is accurate, agree to c mply with all applicable local
ordinances and state laws re ting to build' g construction. I an a r!•presentatives of Cupertino to enter the ab id ntified pro erty for inspection purposes.
Signature of Applicant/Age Date: Z
SUPPLEMENTAL INFO TION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP'`
❑ OVER -TIE -COUNTER
❑ BUILDING PLAN REVIEW,
_ 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'
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ I= DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ .SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06121111
/P