B-2017-1475 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1475 .
10111 WESTMINISTER CT CUPERTINO,CA 95014-5656(342 12 112) AMERICAN VISION
WINDOWS INC
SIMI VALLEY,CA
93065
OWNER'S NAME: MA KENNETH CHI-KIT AND TSOI JAMIE LAN-CHING DATE ISSUED:09/05/2017
OWNER'S PHONE:408-838-0017 PHONE NO:(805)582-1833
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C17 Lic.#778326
Contractors E-IC'►VI 10 I DO i S I C Date 05/31/2018 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: '
REPLACE WINDOWS(24)-LIKE FOR LIKE;REPLACE SLIDING
I hereby affirm under penalty of perjury one of the following two declarations: DOORS(3)'
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
i 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. Sq.Ft Floor Area: Valuation:$35228.00
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 342 12 112 c
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'n consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the .pplican :u .erstands and will comply with all non-point
source regulati. s .er tr- upertinoMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Si re=.7/f� Date 9/5/2017 Issued by:Jasmine Archbold
Date:09/05/2017
A
A . •- I J ' t e
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: I 1 All roofs shall be inspected prior to any roofing material being installed.If a roof is
i.j ,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: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
i. !i'have and will maintain'a Certificate of Consent to self-insure for Worker's
i i Compensation,as provided for by Section 3700 of the Labor Code,for the
' I .performance of the workifor which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 11 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 Labdr Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit iso 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 Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cur•rtin• e unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co.a do 5505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall �`
be deemed revoked, Owa'•-�-or authorized agent: IMMO
APPLICANT CERTIFICATION s :9/5/2017 (.
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING .GENCY
correct.I agree to comply with allcity 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. I understand my plans shall be used as public records. `
/Si nature' Date 9/5/2017 Licensed
,Er. 9 Professional
i„,,a
C+•
' osz,/ GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
/.40s1.);4:; 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 •
(408)777-3228•FAX(408)777-3333•buildings cupertino.orq MIS C
CUPERTINO
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL El MISCELLANEOUS
PROJECT ADDRESS APN# Z— 1 1 ` Z
10 t i I VJ&S�m InS4.er Lf 31/4.{2 A VZ...
R NAME PHONE E-MAIL'
O
`'` e.nne�l� * J Csmje M� LI02,- 3$ °0011 TxMe, Z'4 Gc,nnc.kS-1 , inei-
STREET ADDRESS CITY,STATE,ZIP n c- F
(0 11'1 We c-I- rn n St.r 04 Cur --lint CF y
AN
CONTACT NAMEPHONEE_mAIL d A16t M6 A.rnz-1 c R n
��vld NAOrkl%� 402. -14i-1-T111 ✓vl sth, o*1t6,ciow$ .Lazr
STREET ADDRESS , C ST TE,ZIP 8 r ( lac-
.Li.00 N1o.4-e1M S-t G �'-
1 A C' 950-SD 0 1O l
0 OWNER 0OWNER-BUILDER ' 0 OWNER AGENT 0 CONTRACTOR 1R CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC#
FkrYte.a.tcaA \I1s46P'\ \'ia-c!0t43 11232 LI-1 ' 46 1\
COMPANY NAME.nn ,,rr ` " ) E- `' r FAX
i�'MQr lGr. 'V '3S' V\Ii+�G�d�` f 2ritG,nV'iSran i�iCIUWS, COn, yip$ (911'Oc1pS
STREET ADDRESS I 't��v
.11/4:4 cL1 e" s_4CITY,STS`ATE,ZITP C-kr A CC' CIS. (1.S O $�, Cit,3 - 1 S‘.1 9
'ARCHITECT/ENGINEERf NAAME'�/�. 'h LICENSE NUMB BUS.LLC#
COMPANY NAME \ E MAS FAX
STREET ADDRESS \ CITY,STATE,ZI� PHONE
USE OF. DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN YES
.
BUILDING: r ❑COMMERCIAL URBAN INTERFACE AREA 0 NO FLOOD ZONE 0 NO EICHLER HOME? 0
DESCRIPTION OF.WORK ` I r 1
imyk ref Reernert W' nct0G.�' oZ`{ 5t',A,fi� �ay,6
600r5 . S"i 7 -Co. C., -22 0 0 w IVl ,‘ ow:, Gr re IvA ,'I . 'i le‘
S etI 1 3 c( OCT rt a , 1 -c: .n, 1"1 l 1 C'7 vu,,n ic U -'
Q61� . F;
TOTAL VALUATION 41, --2,-s •Z sc.? RECEIVED BY 1 T_ 4s
JV`/� Al 1.06c9.0.04 s : '
By my signature below,I,certify to eac'of the ollowing: 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 .1\,-provi.•d is correct. I have read the Description of Work and verify it is accurate. I agre, to comply with all applicable local
ordinances.and state laws relatin:. _construction. I authorize representatives of Cupertino to enter the ab ., 4 rre. :-operty for inspection purposes. '
SignatureofApphcantIAgent: `f/1 I Date: 1/
S 'PLEMEN INFORMATION REQUIRED , . , OFFICE USE ONLY,
W ❑ OVER-THE-COUNTER
•
E., ❑ EXPRESS'
• U
❑`STANDARD'
E ;LARGE
a --
•
. ' ❑.MAJOR .
MEPMiscApp_2011.doc revised 06/21/11