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B-2016-3292 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3292 649 PHIL CT CUPERTINO,CA 95014-4654(375 42 020) L N B CONSTRUCTION INC MILLBRAE,CA 94030 OWNER'S NAME: CHU DAVID CHI-HO AND WONG MEI LENG DATE ISSUED: 11/14/2017 OWNER'S PHONE:408-230-1168 • PHONE NO:(650)652-9828 LICENSED CONTRACTOR'S.DECLARATION BUILDING PERMIT INFO: • License Class)3 Lic.#818680 Contractor L N B CONSTRUCTION INC 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: 1ST FLOOR REMODEL MASTER BEDROOM/KITCHEN/LIVING I hereby affirm under penalty of perjury one of the following two declarations: ROOM(763 SF);REAR ADDITION(365 SF) i. I ha a and will maintain a certificate of consent to self-insure for Worker's ompensation,as provided for by Section 3700 of the Labor Code,for the erformance of the work for which this permit is issued.iL.......,,e .60000 Of 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:365 Valuation:$80000.00 • ' 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 375 42 020 R-3(Custom) • ' representatives of this city to enter upon the above mentioned property for . inspectiion.purposes.,'(We)agree to save indemnify and keep harmless the I City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against aid City in con-equence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the app iea;' understa ids an.will comply with all non-point source regulations.er tie C pertim,M is pal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Si hire4. . Date 11/14/2017 Issued by:ABBY AYENDE 7 Date: Il/14/2017 __ ___ _ 1 . LER-B ILDER DE •RATI a r, , 'I hereby affirm that I ant exempt from she Contractor's License Law for one of the RE-ROOFS: following two reasons: Allroofs shall be inspected prior to any roofing material being installed.If a roof is t." 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) ' , 2. I,as owner of;the property,am exclusively contracting with licensed Signature of Applicant: contractors to;construct,th'e'project(Sec.7044,Business&Professions Code). Date: 11/14/2017 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 a: 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 eq 'pment or d:vices which emit hazardous air contaminants as defined by the Bay rea Air I ,lily Management District I Worker's Compensation laws of Califomia. If,after making this certificate of will maintain compliance with the Cu.erti,o Mu pal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S'cfi i s 5 I 25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. O err or authorized agent: , APPLICANT CERTIFICATION ' e:11/14/2017 ' I certify that I have read this application and state that the above information is I► T t II► LED t • V correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction le . r g 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. 197,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 andwill 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. • Signature Date 11/14/2017 Licensed Professional 1 CONSTRUCTION PERMIT APPLICATION . \gi,• COMMUNITY DEVELOPMENT'DEPARTMENT•13UII.DING DIVISION • 5;:+,5, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 COPE R't'INt (4'08)777-3228•FAX(408)777-3333'•buildlne a,cupertino.org ER A iiLT : `d/TI 0 REVISION/DEFERRED OR]GINALPERM1Tit ❑NEW OONSTIt.UCTIQN ... D ADDITION. .,.. .. _. ..,. .,ws .: .. ... ... ,. . . _ . . .:. . .. PRDJECTADDRESS raG 1 � APNR oL IL. c C:�.. �'kn1) n _ �'s-4�-020 ,, OWNER HAMS lJ l l.t W rl lJ PHONE i�U`,2, '••,I J'2 t E-MA]L i/i L.c-. 01'-r"0�l Clivi oo.C-0sA'4- ,; ;STREET ADDRESS 6 t /� CITY,STATE,Zip 6 � � PAX / CONTACT NAMB PHONa r E-MAIL ii t'� t�� �-�-'� �- 1+0b- L $LT3 ca�ati r neo @d-s Tare.sive i o,.ton, P $TRERT"DRESS 2.I 93 SuM,Ane{/lri 1)t, my,srs,Et'L EP n '- c• R f 222-.. 1 rAx Cl OWNER 0 OWNER-BUILDER Q OWNER AGENT CI CONTRACTOR 17 CONTRACTORAGBNTjar- ALIBI ISECT Li ENGINEER 0 DEVELOPER 0 TENANT CONT]tACTORNAMEg �--LICE ENiJMBER ,,i 6r LiCENSE,TYPII RUE LION 40:046:p ) i . COMPANY NAME L....1\1V" 06._T�l(?'v'b ,.C�'.c' f MAIL' b, Y-^-A I I. �j' '6 , 4it/1„4,k--- ! G' .-. �" ' STREET ADDRESS V(, v°l CITY,STATE tP, PH°NII nth Uo i+ ti'(�(.'I C �S�' L:IT. o` --1 3 28)6 . ARCIIITPCT/RNOINI?ERNAME LICT•NSENUMBED. BUS,ucii -,_. • COMPANY NAME E-MAIL MX •' ' STREBT ADDRESS CITY,STATE,ZIP • PHONE )6, .-. -. . . ....�.1).—..._...__ ..,e,,,.o..., DESCRIPTIONOP WORK • rete-eIl6 '. Gbo tv� ud1A 1'C °Ail 1 k n Lwtpi. _�..rlor,A.. 1 eodrooAft �, 601))6/© orn gra neii La�,r dlr iU��V AAA 1 k csi. it PiS\•2r• he al r a om, 0.( x'3.1 s.•5 c - ' /-al (b.tin I-.° Bed' .. — A l;z- .15 c EXISTINGUSR • PROPOSED USE CONSIR,TYPE BSTORYS USE TYPE OC .; SQFT; VALUATION ($)) W Y IXsro • NEW POOR ' DEMO TOTAL AREA } 1. AREA l'' 14 . I AREA .NET AREA O r,131. V V 1 V BATHROOM KITCHEN, OTHER REMODEL AREA CS Gl RF,MODELAREA `5b REMODEL AREA �1""1 l . PORCH AREA _ IICKI AREA I TOTAL DECK/PORCH AREA GARAGE AREA;~J El urACFI • ,il%t P// ' , I ATTACH -7/DWELLING UNITS; IS ASECOND UNIT ❑1MS SECOND STOW OYES --" BRING Ammo? 00 ADDITION? t30 "'�rI PItIt-APPLICATION ❑YES WYES,PROVIDE COPY OF IS THE BLOC,AN iJ YES BY E. =:�. -"`:..E. ;;:;c : TOTAI LUATION: • • PLANNING APPLE ONO PLANNINGAPPItOVALLETTER EICHLERHOME? Li ND y:,-•s._•. ,'•.-.,'•: ..''.:-_ _ -_..-.' . 13y my signature below,I certify to euch of the.followiug: I am the piwperty owner or authorized rig-nt to act on the property owner's behalf. WI:1;e mad this application and the information I have provided is correct. I have read the Dese iptionof Work and verify it is accuate. I agree to comply with all applicable local • ordinances and statelaws relating tobuilding conslruction. Iauthorize representatives of-Cupertino to enter the above-id entified properly for inspection purposes, Slgtuttiu+e of Applicant/Agent: 61•17Au$(g, Date; 12/20/16 , . SUPPLEMENTAL INFORMATION REQUIRED „.--i..,-,,,,•-1,..-.:.,._•-• • ;:-�;-<:; ;,:..4..;;:;a:_r- -VtiO!i= ; = dwellings: Apply • s = , r, i;2:?�_' R7t; - - - New 4liD orMultifamily dwe gs, for demolition permit for :.®_ ttil'i .:. : _ •::�s r':soi-i ,fo gv�n rrrli oina r�izr;;,,- �. =uiilq liY}� t` n t 1 >w- existing building(s). Demolition'permit is required prior to issuance of building ,2 s -r• ;1 permit for new building. '1 ::EX1'.UES$• , 44:iffL•AA'1�IAG vd REI u; -”.`'...."- • _Commercial Bldgs; Provide a completed Hazardous Materials Disclosure ' W -'"V'I'Llil `l'LI-`�''i"i`'r _,:=r_ir,' _•=: _ p :l�sT.�iviS;�n �:�U?:�:;t;:ii-�'ris:_.: UIL�G.t'o Ics:-:,,,a....,;..;, __ £oruiifttnyIiazardousMaterials•aiebeing used Bspart ofthis project, •�� --•-•-':---i::�:��•-'••.��T.--� ••-°- - ----••-••'-' " •••• �1T7;:LAi1:GI;:'F' :;CI'1?I1 DLI-i's' - _;s Copy of Planning Approval Letter or Meeting with Planning prior to - - - `n% ¢"-- - §AtffT .'3,s1S-Rvsri'e° .submittal of Buildin Permit E lication, ; i _ d : i nm mig - ,- -,.. °r ,Pg7p._ :FIAMIP.InRIMMI.I IROisf1•IEN'1 AI iIIIALTlti=:vR•:.a BldgApp,2011.docrevieed 06/23/11 • • • 1