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B-2017-1732 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1732 10480 ORANGE AVE CUPERTINO,CA 95014-2826(357 19 064) A-1 HAULING CAMPBELL,CA 95009 OWNER'S NAME: NING HUAZHONG AND CHU HENGQING DATE ISSUED: 10/09/2017 OWNER'S PHONE:650-314-8837 PHONE NO:(408)978-2903 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C12 Lic.#618640 Contractor A-1 HAULING Date 04/30/2019 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: DEMO POOL(828 S.F.)-USE FOR LANDSCAPE PURPOSES ONLY 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. Sq.Ft Floor Area: Valuation:$9500.00 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 357 19 064 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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Si.,leieLI1 Date 10/9/2017 Issued by:Jasmine Archbold r Date: 10/09/2017 OWNER-BUIL I,' DECLARATION 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 i. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 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) 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:10/9/2017 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 2. 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 t r,elH .lth&Safety Code,Sections 255 , 533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. authorized age : APPLICANT CERTIFICATION 10/9/2017 / I certify that I have read this application and state that the above information is CONSTRUCTI 6 N 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 herebyauthorize 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 10/9/2017 Professional CONSTRUCTION PERMIT APPLICATION \',..„ � COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION „6,, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ='' (408) 777-3228 • building@cupertin.o.org PEMIT#B-,.2 0 (1 - 1.13 2- CUPERTINO CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF NIMMING POOL/SPA PROJECT ADDRESS J`, , s,r ��1� `� APN I S.1 --- (. - !�Gr _ OWNER NAME C" `V U V PHONE ;O o-3/q- /c�- _ _(Di�di E-MAIL l STREET ADDRESS CITY, STATE,ZIP 50141 -e Or. 111.s1‘-° 95O// [KONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE — � z. I ��t21Zr/ �/7�c�j`4-,4-, /19-- / 6f% Ya e1I STREET AI5DRESS CITY,STATE, ZIP Po4ox' 1 ZI Z etaryrp4z 17 c SS o� /� E-MAIL PHONE BUS.LIC# 0 ARCHITECT 0 OWNER ❑OWNER AGENT [�CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME 4E-MAIL ' /4 STREET ADDRESS CITY,STATE,ZIP PHONE Svc f io ,e I2f7 c.4/1, eif 9 -Ox' ? g7v.-203. DECRIPTON / r / Al ��( � 9000 i off ink d S t-/ /tel i©A/ //3 /d J' l e 9 Z 53 s NGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED BATHROOM SE SF SF SF 0 DETACHED 25C 75-00 EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION O YES FIRE SPRINKLERS 0 NO 0 NO NO • DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F IPOOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED (]YES ❑NO I TOTAL-SF RECEIVED BY: T490,TAL VALUATION: , Commercial or Multi-Famiht Buildings with Public Swimming Pools requires Department of Environmental Heath approval ; ` D 0..0-0 . RE-ROOF EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'h" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OR ❑CDX OTHER •12 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 #of 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 of Cupertino to enter the above-identified property for inspe tion pu )oses. I acknowledge and authorize all information contained on this application form to be made available for public record. _' �6/ / Signature of Applicant/Agent: Date: ( 7 7 SUPPLEMENTAL INFORMATION REQUIRE I' *New SFD/Second Dwelling Units/Multifamily 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 BldgApp_2017.doc revised 08/01/17