B-2017-1472 • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1472
20735 STEVENS CREEK BLVD STE H CUPERTINO,CA 95014-2104(326 32 054) RTJN ENTERPRISES
INC
CONCORD,CA 94519
OWNER'S NAME: LAU ALLAN CHOOK YEE AND LINDA YIM SEUNG ET DATE ISSUED:09/06/2017
OWNER'S PHONE:925-676-0119 PHONE NO:(925)676-0119
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#698514
Contractor RTJN ENTERPRISES INC Date 10/31/2017 BLDG ELECT _PLUMB
MECH_RESIDENTIAL X COMMERCIAL
I hereby affirm that 1 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:
HABIT BURGER-T.I.PREP;(2338 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
1 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:$20000.00
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 326 32 054
•
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 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 regulation�ns��per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sin re Q-4)-t_ Date 9/6/2017 Issued by:Jasmine Archbold
, Date:09/06/2017
OWNER-BUILD E WDECLARATION
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.
said(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:9/6/2017
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 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 Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall . `
be deemed revoked. • Owner • t,;:,.horized agent: t$lfAJZ4
kk
°j _
APPLICANT CERTIFICATION Da • • CONSTRUCTION LENDING AGENCY
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 . 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.
Licensed
Signature Date 9/6/2017 Professional
// CONSTRUCTION PERMIT APPLICATION
IV COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
/�S�r.,9Js ` 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
I Li
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinci(a cupertino.orq /� �
❑NEW CONSTRUCTION ❑ ADDITION ® ALTERATIONC /TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
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PROJECT ADDRESS $ e as
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OWNER NAME G�1bb � '14u.
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STREET ADDRESS CITY,STATE,ZIP FAX
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CONTACT NAME 'r_ PHONE E-MAI f
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❑OWNER ❑ QWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER
1 LICENSE E j BUS.LIC B
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COMPANY NAME
E-MAIL
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STREET ADDRESS � ���� CI STATE,Z.I�1 eA 611514 PHC�jS'�? '•aP ley
ARCHITECT/ENGINEER NAME, LICENSE NUMBER BUS.LIC#
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COMPANY NAME •• -MAIL • FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
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DESCRIPTION OF WORK • "
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EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. . SQ.FT. VALUATION($)
R a 'urdtli 03412°wla '! TOTAL
V•8��rtldt
EXISTG NEW FLOOR DEMO TOTAL
AREA e1 7lg AREA../ ARE�,ss NET AREA 2'sys
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
2 �F c3{ 5F 1 !J8 5F
_PPO�Rtpi AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: []DETACH
WR�O `F //�, 3?�{SF
...VA ❑ATTACH
#DWELLINGUNITS: /•'" IS A SECOND UNIT YES SECOND STORY YES
BEING ADDED? NO ADDITION? �NO
PRE-APPLICATION YES IF YES,PROVIDE COPY OF IS THE BLDG AN YES /
❑ REC D B TOTAL VALUATION:
PLANNING APPL# gi NO PLANNING APPROVAL LETTER EICALER ROME? NO e s `'
By my signature below,I certify to each of the following: I am the property owner or authorized gent 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 itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-ide/Miled property for inspection purposes.
Signature of Applicant/Agent: Date: Q!�
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE < , + x _ ....`,F•:3 ROUTING SI IP4 ._.
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ `OVER THE COUNTER 6 '
❑ BUILDING PLAN RE'YIH W
existing building(s). Demolition permit is required prior to issuance of building r
permit for new building. ❑ EXPRESS ❑ PLANNING PT AN REVD w
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ,
❑ ,LARGE - r ❑ F,IJYE DEPT ,
—submittal
of Planning Approval Letter or Meeting with Planning prior to I
submittal of Building Permit application. ❑ AOR r ;
SANITAR}SE1'fER,4,,:w ICT,
,j,a ,_ ❑r`ENVIRONIIIENTAI III LTH ". ,
BldgApp 2011.doc revised 06/21/11
MILLENNIUM
CONSTRUCTION GROUP
September 5,2017
City of Cupertino
10300 Torre Ave
Cupertino, CA 95014
RE: Habit Burger Grill#254,20735 Stevens Creek Blvd. Suite H, Cupertino,CA 95014
To Whom it May Concern:
This letter shall serve as authorization for Steve Hale,Agent for Millennium Construction
Group,to pick up the permits for our project located at 20735 Stevens Creek Blvd. Suite
H, Cupertino, CA 95014.
Any questions,please contact my office at(925) 676-0119.
Thank you,
AdOF
Rich Timmons
President
2888 Concord Blvd. • Concord,CA 94519-2609 • Phone(925)676-0119 Fax(925)676-0329
Website:www.millcongroup.com Email: mail@millcongroup.com
CA.CSL No.698514
WA:CC#MILLECG850N4 • OR:#206140 • ID:RCE#39556,• MT:CCR#222679