B-2017-0973 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0973
21725 REGNART RD CUPERTINO,CA 95014-4820(356 24 043) PETER WANG
MT VIEW,CA 94040
OWNER'S NAME: FEIST MARION JAND LINDA J TRUSTEE DATE ISSUED:06/21/2017
OWNER'S PHONE: PHONE NO:(650)906-8788
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#807017 •
Contractor PETER WANG Date 04/30/2018 X BLDG X 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-(110 SF);2ND FLOOR MASTER BATH/HALL
I hereby affirm under penalty of perjury one of the following two declarations: BATH(200 SF);PANEL UPGRADE-(200 AMP)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -CHANGE 200 AMP PANEL TO(100 AMP)SUB-PANEL-
Compensation,as provided for by Section 3700 of the Labor Code,for the LAUNDRY ROOM-ISSUE 7/18/2017
performance of the work for which this permit is issued. REV#2-REPLACE WINDOWS(11)LIKE FOR LIKE-9/5/2017
foi 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:$50000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 24 043
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 comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
.nature Date 9/ /201T Issued by:Kim Dunbar
Date:06/21/2017
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,1 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:9/5/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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
a. I certify that in the performance of the work for which this permit is issued,1 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 l
Worker's Compensation laws of California. If,after making this certificate of 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,Section 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall -
be deemed revoked. ,�/ L�
Own r�; authori _
APPLICANT CERTIFICATION • "'a." 0
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 representatiyes 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. I understand my plans shall be used as public records.
Licensed
Signature Date 9/5/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
4 .t, (408)777-3228 • building@cupertino.org. PEMIT#B-l _ -
CUPERTINO O -13I)EF#
❑ NEW CONSTRUCTION ❑ADDITION ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING TOOL/STA
PROJECT ADDRESSAPN#
Otr)
OWNER NAME �k PHONE E-MAIL
STREET ADDRESS
❑CONTRACTOR i.NAME OWNERR B ` COMPANYr i. —Y CITY,STATE,ZIP NAME LICENSE NUMBER LICENSE TYPE
I STREET ADDRESS CITY,STATE, ZIP
67) �y �;-e) m,4- 5'4/c 526
E-MAIL PHONE BUS.LIC#
•
0 ARCHITECT 0 OWNER 0 OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME /� ��) E-MAIL
�e/r/ti- !i V a
STREET ADDRESS __Yd- kyr / CITY,STATE,iPHONE
/ i - t d
DECRIPTONr, /�Trb Z ) T 1 )`12 L s // d %
.❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC • SQ.FT. VALUATION($) ,
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
•
EXISING ❑YES .EICHLER ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING I SECOND DWELLING 0 YES 0 ATTACHED❑DETACHED OTHER
UNITS'# UNIT ADDITON: ❑NO S F
POOLS' ❑FIBERGtASS,0 VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL SF SPA-SF .' SPA ATTACHED ❑YES i NO TOTAL-SF f
D BY: TOTAL VALUATION/:
,Commercial or Multi-Famil u Buildings with Public.Swinmaing Pools requires Department of Environmental Heath approval /er �..�_, 1 tl /• !' b
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) , \
REMOVE/REPLACE 0 NOI ❑IF NO PLYWOOD ❑1" El 3/8"
3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
YES #OF LAYERS THICKNESS 5/8" OTHER ❑OSB ❑CDX OTHER A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER .
*Provide a signed copy of the 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 owlier'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 authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. I a edge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date: r--- �.
(7_,
SUPPLEMENTAL INFORMATION REQUI D .
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for a ll.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
.
•
BldgApp_2017.doc revised 08/01/17 .
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0973
21725 REGNART RD CUPERTINO, CA 950144820 (356 24 043) PETER WANG
MT VIEW, CA 94040
OWNER'S NAME: FEIST MARION J AND LINDA J TRUSTEE I I DATE ISSUED: 06/21/2017 1
OWNER'S PHONE: 510-396-5899
License Class ]3 Lie. #807017
Contractor PETER WANG Date 04/30/2018
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.
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
��M°�unicipal Code, Section 9.18.
1
Signature l r1",;C !/�1noDate 06-21-2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 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).
PHONE NO: (650) 906-8788
BUILDING PERMIT INFO:
BLDG X ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
KITCHEN REMODEL -(110 SF); 2ND FLOOR MASTER BATH/HALL
BATH (200 SF); PANEL UPGRADE - (200 AMP)
Sq. Ft Floor Area: I Valuation: $50000.00
APN Number: Occupancy Type:
356 24 043
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: 06/21/2017
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: 06-21-2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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.
Signature Date 06-21-2017
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 25505, 25533, and 25534.
Owner or authorized agent:
Date: 06-21-2017
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
Profession
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0973
21725 REGNART RD CUPERTINO, CA 950144820 (356 24 043)
PETER WANG
MT VIEW, CA 94040
OWNER'S NAME: FEIST MARION J AND LINDA J TRUSTEE
DATE ISSUED: 06/21/2017
OWNER'S PHONE: 510-396-5899
PHONE NO: (650) 906-8788
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lie. #807017
Contractor PETER WANG Date 04/30/2018
X BLDG X 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 -(110 SF); 2ND FLOOR MASTER BATH/HALL
I hereby affirm under penalty of perjury one of the following two declarations:
BATH (200 SF); PANEL UPGRADE - (200 AMP)
ave and will maintain a certificate of consent to self -insure for Worker's
REV#1 - CHANGE 200 AMP PANEL TO (100 AMP) SUB -PANEL -
mpensation, as provided for by Section 3700 of the Labor Code, for the
LAUNDRY ROOM - ISSUE 7/18/2017
rformance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance, as provided for by
ction 3700 of the Labor Code, for the performance of the work for which this
)certify
Sq. Ft Floor Area:
Valuation: $50000.00
rmit is issued.
APPLICANT CERTIFICATION
I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
356 24 043
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 comply with all non -point
source regulations per the Cupertino Municipal Code, Secti n 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature ate 07/18/2017
Issued by: Kim Dunbar
OWNE -BUILJR DECLARATION
Date: 06/21 /2017
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
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)
z. 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: 07/18/2017
I 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
z. 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. 1 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 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, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 07/18/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTIO 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 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 07/18/2017
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY 10300 TORRE AVENUOE MCUPERTINO CA 95014-3255 BUILDING DIVISIO �` `IS1^�
(408) 777-3228 •FAX (408) 777-3333 • buildingacupertino.orcl
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI )7rREVISION DEFE D ORIGINAL PERMIT #
ADDRESS 777-PNg"'
VPROJECT r
/. V
OWNER NAME
HON�lb1�`
J E-MAIL
ADDRESS n'pcITY,•STATE,
ZIP
7F.STREET
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
TF
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT
❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
+ I 1
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
��
E-MAIL
FAX
STREET ADDRESS l ^- �(7 _� „ � ria �
��/ �/� Y
CITY, STATE, ZIP
Y n-y-�t ` 1, D - I
Y 1/ l 1 V
PHOTV bre) / 1 O/�
! V / % V
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LTC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK / V Y Y ,e_ 1
2-oo `-c,Q
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
1
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
I
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH ARE
GARAGE AREA: DETACH
ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? [3NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RE D BY
OT L y�ALL}AT.{Q,'� t
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
J`//j C//l U
By my signature below, I certify to each of the following: I am the property owner or authorized a ent 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 and state laws relating to build' nstruction. I Ithol .ze representatives of Cupertino to enter the above -identified property for inspection rposes.
Signature of ApplicanUAgent:
Date: 77—
1( f 2 C%
SUPPLEMENTAL I9FORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-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 by ing
permit for new building.
❑ EXPRESS
❑ PLANNllVG PLAN RLVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
El PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SENVLR DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTALITEALTH
B1dgApp_2011.doc revised 06'21/11
WE