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B-2017-1226CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1226 19900 PRICE AVE CUPERTINO, CA 95014-3339 (369 04 029) MORGAN'S OUTDOOR LIVING INC FAIRFIELD, CA 94534 OWNER'S NAME: KWOK EDWARD C AND IRENE L TRUSTEE DATE ISSUED: 07/26/2017 OWNER'S PHONE. 408-257-8308 PHONE NO: (707) 428-3302 LICENSAD CONTRACTOR'S DECLARATION BUILDING PERMIT INFO' License Class a Lic. #912988 Contractor MORGAN'S OUTDOOR LIVING INC Date 0.3/31/2018 X BLDG _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 INSTALL ATTACHED arbor (12'X 12') I hereby affirm under penalty of perjury one of the following two declarations: 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. 4yI 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: $3200.00 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 APN Number• Occupancy Type: and state laws relating to building construction, and hereby authorize 369 04 029 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 equence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant and stands and will comply with all non-point source reg�tations per the C pertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur4 l Date 07-26-2017 Issued by Kim Dunbar Date: 07/26/2017 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 r. 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 ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 07-26-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 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 material. Additionally, should I use equipment 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 Bay Area Air Wty Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the C pertino M 'cipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Cod , Sections 255 , 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: 07-26-2017 I certify that I have read this application and state that the above information is N TR EN Y I hereby affirm that there is a construction lending agency for the performance 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 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 ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 07-26-2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • buildinaacupertCVPERTIN.0 ino.or ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS � ` b � f, �� j r �; r/ APN # OWNER NAME �„/ � ff�e-�-u° r S V IJ � "Jrt/ E-MAIL STREET ADDRESjgq O�DUl3 , y/ CrrT T�w y ae FAX CONTACT NAME P C!I►(,✓� i E-MAIL - STREET ADDRESS MO S W - CITY, STATE, ZIP FAX IJ OWNER ❑ OWNER -BUILDER. N TEN, ElCONTRACTOR AGENT ❑' ARCHITECT 11ENGINEER El DEVELOPER E TENANT CONTRACTOR.NAME LICENSENUMBER LICENSE BUS. LIC# COMPANY NAME 3046•B ROckdle - 4 A It.�(�tom/ Rhtlk�a�S }�%..�.` Vow, Q\( (A9+ � FAX STREET ADDRESS FMOUPllu) CITY, STATE, ZIP Co PHONE 423-3302 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS., LIC # COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORKS`l, C P v EXISTING USE - PROPOSED USE CONSTR. TYPE # STORIES - -- USE TYPE OCC, SQ,FT. VALUATION (S) �AIS'l'G NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BNTHR00M - KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL :AREA PORCH AREA DELI.-. AREA TOTAL llECK/PORCH AREA GARAGE AREA: 0 DETACH ATTACH # DWELLING UNIT'S _ 1S A SECOND 11NIT I:] 1'ES SECONDSTORY OYES BEING ADDED? ❑ NO ADDrrION? [:]NO - A. PRF: APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES Ri D i3Y Al, VALUATIO.r PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO'- !" 00 Iiy my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owners Qfkall. I fiave read this application and the information I have vidXdc'ect. l 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 ` i` dinion. I authorize represental v s of Cupp lino to enter the above-idee�ntified property for inspection purposes. Signature ol'Applicant/Agent: Date:_ / �!� ---- I SUPPLEM.' Tt>.L INFORMATI - REQUIRED T'I.ANGHECKTYPE rtOUTINGSLIP. New SFD or Multifamily dwellings: Apply for demolition permit for )�} OVER rH��OUNTER' © BUILI)1NGPLAla REvrEW ` existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ xPR ss NrP� AN knUG I L,'Y,, V1EIN L _ Commercial Bldgs: Provide a `completed Hazardous Materials Disclosure I STANDAkD ti, m , form if any Hazardous Materials are being used as part of this project. . -LARGE a :4- F1RE'DEi"r Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.JOR -Q sAN31ARX6EWER DIS,TR[eT ENVIRpNNiEN'1`�LHEALTH' BlclgApp_2011.cfoe remised O6l2 1, t 1