B-2017-1711 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1711
•
20189 CIVIC PARK LN CUPERTINO,CA 95014(369 55 080) NEW CURRENTS LTD
SAN JOSE,CA 95119 .
OWNER'S NAME: CHENG WOSEN AND LU YONGQIN DATE ISSUED:10/04/2017
OWNER'S PHONE: PHONE NO:(408)784-7521
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lie:#469253
Contractor NEW CURRENTS LTD Date 02/28/2019 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:
REPLACE DAMAGED LIGHT POLE-PARKING LOT
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.
00011
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:$9200.00
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 369 55 080 ,
(representatives of this city to enter upon the above mentioned property for
' linspeCtiOnpurposes. (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
Lhereliy''ffirm9tat I am exempt from the Contractor's License Law for one of the RE-ROOFS: •
•
followingreasons: , 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
:i compensation,will do the work,and the structure is not intended or offered for inspection.
'sale(Sec7044,Business&Professions Code)
2: I I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: '•
i contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/4/2017 1
I'herebyaffirm 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 ALL ROOF COVERINGS TO BE CLASS A OR BETTER
Compensation,as'provided fors y Section 3700 of the Labor Code,for the :',
erformance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. i;, Ihave 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 isl issued, maintain compliance with the Cupertino Municipal Code;Chapter 9.12 and the
• Health&Safety Code,Section 25532(a)should I':store'or-handle hazardous
3. I certify that inpermit performance of the work for which this is issued,
'Imaterial. 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
1 1 air contaminants as defined by the Bay Area Air QualityManagement 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,Se ' n, 5505, 533,'and 25534.
Labor'Code,I must forthwith comply with such provisions or this permit shall :!
be deemed revoked. lr or authorizer'7 ent;.
' ' APPLICANT CERTIFICATION IF
ne
Date:10/4/2017 I`( i 1 ' i.
I certify that I have'read this application and state that the above information is CONSTRU°CTI N LENDING AGENCY
correct.Iagree to'comply with all city and county ordinances and state laws • I hereby affirm that there isa�t'ruction lendinglagency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per it' issued.(Sec.3097,Civ'C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save,ihdeMnify 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 willicbrimpiy'with all Tnbn-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
• Code,Section 9.18. - I understand my plans shall be used as public records.(
Signature Date 10/4/2017 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
V 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 !► 1
(408) 777-3228 • buildinglcuperti.no.org PEMIT#B-
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN a >q v /�,s sS —y�f1
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OWNER NAME
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J CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
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DECRIPTON
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❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL leCOMMERCIAL • I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF. DECK SF DEMO SF STORIES a TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑NO ❑ NO ❑NO '
DWELLING SECOND DWELLING ❑yES ❑ATTACHED DETACHED OTHER
UNITS a UNIT ADDITON: ❑NO S F
POOLSI ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED '
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
RE � ��D�BY: OTAN
pT r L VALUA N:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department oJEnvironniental Heath approval ' ' -* c �.i/
RE-RO OFEXISTINGROOF TYPE: BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES WO�ODDSHHI�NGL 0 TIL OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑14„ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES 0OFLAYERS THICKNESS❑5/8" OTHER ❑O5B ❑CDX OTHER '112 A
PROPOSED ROOF TYPE:.❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF aof 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 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 construction. I authorize representatives ofi:Cupertino to
enter the above-identified property for in• ctioy purposes. I acknowledge and authorize all information contained on this application form
to be made available for public-cord. / /�r y- �/�
Signature of Applicant/Agent: V Date: -
7
SUPPLEMENTAL INFORMATIO h.EQUIRED
*New SFD/Second Dwelling Units ltifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide. 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
BldgApp_20/7.doc revised 08/01/17
Abby Ayende
10/04/17
Abby Ayende
10/04/17
Abby Ayende
10/04/17
Abby Ayende
10/04/17
Abby Ayende
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Abby Ayende
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Abby Ayende
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Abby Ayende
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Abby Ayende
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