B-2017-1376CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1376
20627 SUNRISE DR CUPERTINO, CA 95014-2928 (359 10 021)
TITAN GENERAL
CONSTRUCTION INC
FREMONT, CA 94539
OWNER'S NAME: CAO YAHONG
DATE ISSUED: 08/17/2017
OWNER'S PHONE: 408-707-9817
PHONE NO: (408) 883-8668
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B C Lie. #948867
Contractor TITAN GENERAL CONSTRUCTION INC Date 06/30/2018
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:
(I) TEMPORARY POWER POLE (100 AMPS)
I hereby affirm under penalty of perjury one of the following two declarations:
z. 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
ormance of the work for which this permit is issued.
z AM 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: $500.00
r permit is issued.
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
and state laws relating to building construction, and hereby authorize
359 10 021
representatives cfIN6 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 theertino unicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
ature Date 8/17/2017
Issued by: AbbyAvende
OWNER-BUILDER DECLARATION
Date: 08/17/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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: 8/17/2017
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
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. 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
shall not employany 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 Mnw kWpaKode, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
he Health & Safety Code, Sectio 05,255 ,and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
- ner or authorized agent:
APPLICANT CERTIFICATION
ate: 8/17/2017
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 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 8/17/2017
professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-32550
(408) 777-3228 • building@cupertino.org PEMIT #B - -
CUPERTINO REV # DEF #
[:]NEW CONSTRUCTION []ADDITION ❑ ALTERATION ❑ T.I. MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS r� � , 5wv i �
L V
APN # ?Gq—
OWNERNAME PHONE
4 L _
/E-MAIL
STREET ADDRESSCITY,
D
STATE, ZIP
CONTRACTOR NAME. ❑OWNER -BUILDER COMPANY
�� c
NAME
ria .�C
LICENSE NUMBER LICENSE
.7 �'�? �
TYPE
V
STREET ADDRESS � CI"I'Y, STATEr IP
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E-MAIL
PHONE
BUS. LIC #
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT[:] ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP PHONE
DECRIPTON
INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL []COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
I DEMO SF
STORIES #
TOTAL NET SF
REMODEL
BATHROOM SF
REMODEL KITCHEN
SF 'i
REMODEL OTHR
SF
GARAGE ❑ ATTACHED
SF ❑ DETACHED
EXLSING ❑ YES'EICIILER�
FIRE SPRINKLERS ❑ NO
❑I� XE3
�• ;,j ❑ .NO
SECOND STORY ADDITION El YES
❑ NO
DWELLING SECOND DWELLING .❑yEs ATTACHED ❑DETACHED OTHER
UNITS # UMT ADDTTON: 0 Np'.! SF
POOLS ❑;FIBERGLASS ❑IVINYL-LINED ❑ GUNrM ❑ PREFABRICATED
POOL - SF SPA SF I I I! SPA;ATTACHED ❑ YES N NO TOTAL - SF
Commercial or Multi-FamiluBuildi�nQslvuith:Pubfie�Se<rimuiin�Pools requires Department of Environmental Heath approval
R IVED BY:
I MIA
TOTAL VALUATION:
I 11A
RE -ROOF EXISTING ROOFTYPE: ❑ BUILT-UP ROOF EJASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHIN LES TILE OTHER (SPECIFY)
REMOVE /REPLACE Q NO
[:]YES I
JIF�NO ` '
I !#jOF L ,YERS
PLYWOOD ❑'� ❑ 3/8" PLYWOOD
THICKNESS [:]5/8" OTHER
TYPE:
[:]OSB[:]CDX OTHER
PITCH: ROOF CLASS
12 A
PROPOSED ROOF TYPE:I❑BUILT-UP'ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy of+the Cuf tin's Tear -Off Policy SF #of SQUARES
By my signature below I1 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 applicationand 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 st ws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified,property; for inspection purp es.=owledgend authorize all information contained on this application form
to be made available, for'pilblic record.
Signature of Applicant/Agent: �' Date: 21
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/MulHfamily 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
I, ' I
B1dgApp_2017.doe revised 08101117