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B-2017-0652CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0652 1070 COLONY HILLS IN CUPERTINO, CA 95014-5825 (359 28 012) TITAN GENERAL CONSTRUCTION INC FREMONT, CA 94539 OWNER'S NAME: LIN SHIJER AND FONGMEI TRUSTEE DATE ISSUED: 08/21/2017 OWNER'S PHONE: 408-777-8105 PHONE NO: (408) 883-8668 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #948867 Contractor TITAN GENERAL CONSTRUCTION INC 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 ADDITION (110 SF) LIVING RM ADDITION (443 SF) I hereby affirm under penalty of perjury one of the following two declarations: REPLACE WINDOW (8) LIKE FOR LIKE TO MEET EGRESS 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 Erformance 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 Sq. Ft Floor Area: 552 Valuation: $99360.00 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 359 28 012 R-3 (Custom) representatives,of this city to enter upon the above mentioned property for inspection purposes. (Vile) 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 regulptient per the Cuperti Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. atureDate 8/21/2017 Issued by: Abby Ayende OWNER -BUILDER DECLARATION Date: 08/21/2017 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 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) 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: 8/21Z2017 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 i 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 MunicipalCode, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code; Sections45505; 533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. _ G=' n or authorized agent: APPLICANT CERTIFICATION Date: 8/21/2017 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 8/21/2017 Professional 11PERTINO ^ I 1 NRW rnw..,TRTT('. nW CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION - 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 , building(cl-MiDerUna.orq P"2- 0 PI to s-- iC.�7 � I—I ATTTTnW I I ALTF.RATTnN i Tr !. I REVTSION 1 DEFERRED ORIGINAL PERMIT 6 N) PROJECT ADDRESS APN t'C^^ tD y9� oWNEiNAME0,rL5'iQLI� $' 77 41 �S E-MaIT 0 i I STRTADDRESS T C„�� LL TATE, ZIP loo 57� FAX CONTACT NAI PHO EMA STREET ADD ARS CITY, STATE, ZIP iJ V.�Ft E 5��� AX ❑ OWNER ❑ OWNER-BUA.DER ❑ OWNER AGENT 11CONTEACrOR CONTRACTOR AGENT 13 ARCHITECT Q45GINEER ❑ DEVELOPER 1l TENANT CONTRACTOR NAME �� / �, ?2:e (tet LICENSB R LL SE BUS. LIC # COMPANY E EMAIL FAX G LaI STREET ADD 5 CITY, STA PHONE I AR6: IITECTIENGINEER NAME ' LUTC SENUhr6BUS. a 6�' LIC # COMPANY, EMAIL FAX n �Q _ t / STREErADDRBSS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK D 1 ya-KWC-ALTA l f (\J01 --0R_ Ll VI 0 i nAJ l0 Md o l E =STINGUSE' Y PROPOS® USE CONSTR TYP II STORIES USE TYPE occ, SQ,FT, VALUATION (S) EXtsTG ARBA k -t /7 NEW FLOOR � ori � AREA 4:1- �-KITTCHEN DEMO AREA TOTAL NBT AREA BATHROOM OTHER RKMODELAREA O REMODEL AREA I 1 Sl ! REMODEL AREA PORCH,ARFr1 DECK AREA - TOTALDECIKIPS OVRCH ARBA GARAGE AREA; DETACH (JJ (QJ ATTACH i # DWELLING UNITS: IS ASECOND UNIT S SECOND STORY DYES BEINGADDED7 NO ADDITION?:, ❑NO - PRE -APPLICATION DYES IFYBS, PROVIDE COPY OF PLANNING APPL # D NO PLANNING APPROVAL LETTER ISTREDLDCAN ❑YESREC EICHLER HOME? ❑ NO - $ ; -y;°=;;'�:;„=Y= s - •y''; TOT�I. UA�'ION: . By my signature below, I 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 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 cons • ctioon. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicaut(Agenf: Date: 7 �2 SL' 7 SUPPLEMENTAL INFOTIONR UIIZED; '= PI AN CHECIc TYP>L_:..� . _.... _ kOiiTlrlSGte"'= - -- New SPD or Multifamily dwellings: Apply for demolition permit for ❑= tltR._:�>aE CoaNTT R _ $p_ := �' ; existing building(s). Demolition permit is required prior to issuance of building _ -- x: — ;: - __-:•••-:-• ernut'fOr new building. : --K.SS= Cotrtmercial Bldgs: Provide a completed hazardous Materials I)isclGsure - _ _ :--.:ij'a-= �•::�'-?:,::.,s: :-'s?ratloAxn�_. -r.:.a _:_:• :.; i=' ii' :ti �' ",-:.:?==:y.:ci.""^ :` is=�''. -M._.,. E11BLIcwouxs ,_;,:., ;_!_ .._.___ _..... farm if any hazardous Materials are being used as part of this project, ❑ !' .iAR(iE - '=`:^_' • FIRLITEPr C6py of'Planning Approval Letter or Meeting with PlanningPrior to NfflK •IeL70ILY-,-; - - E-- submital of Building Permit application, $Idg�011.doc',.W ed 06121111 CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0652 1070 COLONY HILLS LN CUPERTINO, CA 95014-5825 (359 28 012) TITAN GENERAL CONSTRUCTION INC FREMONT, CA 94539 OWNER'S NAME: LIN SHUER AND FONGMEI TRUSTEE I I DATE ISSUED: 08/21/2017 OWNER'S PHONE: 408-777-8105 1 1 1 PHONE NO: (408) 883-8668 License Class TILE (CERAMIC AND MOSAIC) Lic. #948867 Contractor TITAN GENERAL CONSTRUCTION INC Date 06/30/2018 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. 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. 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 Cu ertino Municipal Code, Section 9.18. Signature ate 1111/2018 __4� 4� I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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.7M4, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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. 11T.77-- iililf'IsLf:] BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTLAL _ COMMERCIAL JOB DESCRIPTION: KITCHEN ADDITION (I 10 SF) LIVING RM ADDITION (443 SF) REPLACE WINDOW (8) LIKE FOR LIKE TO MEET EGRESS REV #1 - (2) BATHROOM REMODEL (120 S.F.); (3) REMODEL BEDROOM (710 S.F.); ADD 1 BATHROOM (110 S.F.); (N) REAR PORCH (270 S.F.) - ISSUED 1/11/2018 Sq. Ft Floor Area: 552 1 Valuation: $99360.00 APN Number: Occupancy Type: 359 28 012 1 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby A,vende Date: 08/21/2017 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: 1/11/2018 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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:—'l Date: 1/11/2018 CONSTRUCTION LENDING AGENCY 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 understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTIN0 CA 95014-3255 Iml ' 2-0t-�- D&S-?_ (408) 777-3228 • building@cupertino.or;; PEMIT riB - CUPERTINO REV AJ_ DEFn ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.i. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS APN o _t Y�S/ ^ 2--2- oI OWNER NAM ( PHONE 4lll...+++ot ^iii � k E-MAIL , STREET ADDRESS CITY, STATE, ZIP CQ ±V / q- 1 Q b LLC-KTt Jv ❑ CONTRACTOR AME ❑ OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE STREET ADDRESS CITY, STATE, ZIP E-MAIL PHONE BUS. LIC w ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ENGINEER ❑ DEVELOPER ❑ TENANT CONTA NAME E-MAIL a / STREET RESSCITY, STATE, ZIP PHONE v kl .4 a D ECRIPTON r SI ti C ©AJ - R NGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($)� NG USE E NG SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES ♦ TOTAL NET SF NRE l ODEL I REMODE IT REMODEL OTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED YESO EICHLER O O SECOND STORY ADDITION ONO FIREIS SPRINKLERS ❑ O NEXISNG DWELLING SECONDDWELLING ❑YES ❑ATTACHED❑DETACHED OTHER UNITS A' UNIT ADDITON: ❑ NO S F POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA - SF SPA ATTACHED ❑YES ❑ NO TOTAL -SF Conmrerrial ar Multi-Fmvilu Buildings with Pu6lie Swimnrine Pools requires Department ofEnpironmental Heath uwropal EC—Al VE D BY: TOTAL VAlUATIOV. RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES[] WOOD SHAKES ❑ WOOD SHIN LES ❑ TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO IF NO PLYWOOD ❑ rA„ ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS YES v OF LAYERS THICKNESS ❑ 5/8" OTHER ❑OSB ❑ COX OTHER •12 A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER *Provide a signed copy of the Cupertino's Tear -Off Policy SF Qof 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 owner's behalf. I have read this application and the information I have provided is correct. I ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and to laws relating b 'lding construction. I authorize representatives of Cupertino to enter the above -identified property for inspectio ur oses. I acknowledg and authorize all inform tion co �ine this application form to be made available for public record. , O t Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwell gs: A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazar us 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 08/01117