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B-2017-1327CITY OF CUPERTINO BUILDING PERMIT RESS: CONTRACTOR: PERMIT NO: B-2017-1327 DR CUPERTINO, CA95014-4968 (362 06 026) CRAFTSMEN'S tSTAFFORD GUILD INC CUPERTINO, CA 95014 OWNER'S NAME: CHONG WEISIN AND LAW VERONICA SIUSUEN DATE ISSUED• 08/10/2017 OWNER'S PHONE: 408-930-8020 PHONE No: (4118) 366-1000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO' License Class ¢ Lic. #507159 X_ Contractor CRAFTSMEN'S GUILD INC Date 03/3112019 BLDG _ELECT _ PLUMB MECg 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 JOB DESCRIPTION license is in full force and effect. KITCHEN REMODEL - (250 SF); BATHROOM REMODEL - (160 SF); I hereby affirm under penalty of perjury one of the following two declarations: REMODEL OTHER - (280 SF) 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 j s issued. 2. 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 Sq. Ft Floor Area. Valuation: $140000.00 permit is issued. I 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 362 06 026 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which 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 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertino Munici al Code, Section 9.18. Signature Date 8/10/2017 Issued by Jasmine Archbold Date: 08/10/2017 OWNER-ON I hereby affirm that I am exempt from the Contractor's License Law for one of the $F-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: I, of the or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for inspection. r. as owner property, 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 Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date:8/10/20177p I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. 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 Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this California maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I 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 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 25534. exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 2 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ` Owner or authorized agent: APPLICANT CERTIFICATION Date: 8/10/2017 CONSTRUCTION LENDING AGENCY_ I certify that I have read this application and state that the above information is 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 of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city (We) agree Lender's !Name to enter upon the above mentioned property for inspection purposes. to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Ai1CFIITEC 1 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 8/10/2017 Professional CONSTRUCTION PEANUT APPLICATION ,.PA COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 . I (408) 777-3228 • FAX (408) 777-3333 build ingQcupertino.org CUPERTINO ,ry ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION 1 TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # , � c✓ i f PROJECT ADDRESS t` j Ce RO (:4PN / Ob 0 � �j �j O WNE�PHONE _ n E- ZAIL STREET ADDRESS (� CITY, STATE, ZIP f g k m7�y, r� ®. G� �(L I FAX CONTACT NAME I PHONE E-M.AIL STREET ADDRESS CITY, STATE, ZIP FAX OIA'NER ❑ OWNER -BUILDER ❑ OWNERAGENT VCONTRACTOR 0 CONTRACTOR.AGENT ff-�CHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAhlEy� �ye�Giu6IT LICENSIUNBER c LICENSETITE BUS. LIC# .Q �p /+ i � yrs �� COMPANY NAME ( p� i I )`Q%1/> 5 l9 ILCAi E-MAIL FAX �} " ✓ —1 h STREET.ADDRESS 10 6 60 �-Qvlhl-1 yl� RhllZ x N ITY, STATE: ZIP � A� p7 �� ( �9� PHONE G�.,-, p. ARCHITECT/ENGINEERNAME 1t � ry 4�1 LICJENSENUMBER � BUS. LIC 4 tT t9 COMPANTY N AAg E-MAIL FAX STREET ADDRESS IQ b b6 CITY, STATE, ZIP PHONE$ ,, s DESCRiPTION? OF WORIC 10 ^ i' �a^ ppA I M ,1 � Q� � l I4, 7 m Re 1-0 C t� ? roo,-j!, EXISTIIQG tiSE. - PROPOSED USE CONSTR TYPE STORIES Res. USE TYPE OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEA40 [ TOTAL AREA 2'I' 2 AREA — NET AREA BATHROOM KITCHEN /�- OTHER _I REMODELREA40DELAREA �S�O REN20DELAREA AREA /6 ® t? PORCHAREA I DECK AREA TOTALDECICTORCHAREA GARAGE AREA: El DETACH ` ATTACH E DVdELLAG UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES eA t BEL'iGADDED? WNIO ADDITION? NO PRE -.APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES NPD BY ,�� ' , ' 2 ; ' TOTAL VALUATION: PLA1Q\7122GAPPL= E] \10 PLA-\-.\ -G APPROVAL LETTER EICHLERHONIE? ❑NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owners 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 �uthai represeniatives of Cupertino to enter the above-ide tified property for inspection purposes. -' /4l2� i Signature of Applicant/Agent: _ Date: � SUPPLEMENTALI INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition pennit for existing building(s). Demolition pen -nit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure. fonn if any Hazardous -Materials are beim used as part of this project. Copy of Planning Approval Letter or Meeting With Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11