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B-2017-1165 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1165 10675 S DE ANZA BLVD STE 1 CUPERTINO,CA 95014-4449(359 23 033) . YUANLONG CONSTRUCTION INC ROSEMEAD,CA 91770 OWNER'S NAME: SEAGRAVES WALTER M II ET AL DATE ISSUED: 11/16/2017 OWNER'S PHONE:408-483-1965 PHONE NO:(626)213-4599 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#1012793 Contractor YUANLONG CONSTRUCTION INC Date 04/30/2018 X BLDG _ELECT _PLUMB MECH_RESIDENTIAL X 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: FASHON HOUSE T.I.-ADD NEW PARTITION WALL;RELOCATE I hereby affirm under penalty of perjury one of the following two declarations: LIGHTING;ADD OUTLETS;(1295 S.Q.) 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. 42. 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 by permit is issued. Sq.Ft Floor Area: Valuation:$50000.00 • 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 359 23 033 B(Tenant Improvements) 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. Signatu - L I LA-42--- ---"Cl'-9. Date 11-16-2017 Issued by: m Dunbar Date: 11/1/1 6/20.17 OWNER-BUILDER 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 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. 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:11-16-2017 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. 1 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, d 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized age rlt...",...---? • APPLICANT CERTIFICATION Date:11-16-2017 I certify that I have read this application and state that the above information is CONSTRUCTION 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 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 11-16-2017 Professional • _/ CONSTRUCTION PERMIT APPLICATIONeF 114 �`: COMMUNITY DEVELOPMENT DEPARTMENT. BUILDING DIVISION ; _ mil; 10300TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinqcupertino.orq —20 l"1-l1(0 S- ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PVC A7 S 4♦ V.IZ C-(/t )V g- li 1 APN# 2,5-ct - 2:1 -c9 OWNER NAME PHONE E-MAIL STREET ADDRESS CITY,•STATE,ZIP FAX i.O TACT N. I PHONE MAIL au- l,o Li A 4t2R-483-(g/c a(Jcl D a�o!_ con-- STREET ADDRESS J >� �c7A.;-A 4 _ cA qs c' _ ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT �'7 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT rl., TQ broil .,^ �, .��_ _�,,i,6_0^ y LICENSE NUMBER''© 2'1 Q 3 LICENSE TYPE (J BU� 1 0 COMPANY NAME H CiC.e(\2.14kl L i" V lyh yid E-MAIL �l� �i 7 33 IliI,toy,, FAX (/ STREET ADDRESS /' ^ CITY,STATE,ZIP poseppenof a q PHONE yR��TECT/ENGryvEER NAME LICENSE BER BUS.LIC E ' F�t � CGi Imo.�{ f� f7 • C-z8"(4 7 CQM.PA yNAMTEE 1J 1 MAIL it FAX ' LH I Ve_iIG r . inc--. QLICa�Lr dn..G+'0Q.f>/. L'-6�(r STREECT A DRESS u , , C ,STATE I�. ^ �(+ — „NE ,i r r DES C PTION OF OMl t Is A -f c�s�I.—� 140-tx4� e-W/ ' - ' & fake..` f Yinskr.s . lLq v� l ,J peci;-tit.-4 w i L T-5)/1-.L 6-ic t Ld s , & Y.eA- ve �q e 1u oLuct & ?two b%est , --t®�fa.P 0-f V215- 61 , �1 _1 EXISTIN USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL , AREA AREA AREA NET AREA V 6 1/975 5O BATHROOM KITCHEN OTHER Li ��.JJJ"`�� REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH 0 ATTACH it DWELLING UNITS: IS A SECOND UNIT DYES SECOND STORY ❑YES BEING ADDED? 0N ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YESNy4.,.E.P.AWF .'1,.:::1 �, TOTAL VALUATION: PLANNING APPL# 0 NO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO ! . a D 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 behal. 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 relate t /uildipng const-conction. I auth ize representatives of Cupertino to enter the above--identified property for inspection purposes. Signature of Appbcant/Agerit:� - �uM—1 ,i Date: -Gt.1 - t 7 -/V01 SUPPLEMENTAL INFORMATIO 4 QUIRED Aim 4LA14.,i4 K'CYPE I . .Ro13TI G�SLIP .. ,f. ,.;` i� New SFD or Multifamily dwellings: Apply for•- olition permit for ` [ t I E ❑` OVER THE GOYINTERr s❑ TST31�DTNGrELAN REyIEV1 existing building(s). Demolition permit is required prior to issuance of building ,* i *d7 permit for new building. {❑ EXPRESS it AND ❑ LNN ,,NR CEw ' i� � >Commercial Bldgs: Provideacompleted Hazardous Materials Disclosure ❑ STAD `T e © PVL[CWORIs form if any Hazardous Materials are being used as part of this project. # ttl s,:slARCE , s �,:'" s FIRE D PST_ A-M Copyof Planning Approval Letter or Meeting with Planning prior to `❑ � � �� MAJOR e �� a SAITARYEWRMTRIC'Isubmittal of Building Permit application. I i igntig ni ..,E ❑r-ENVIRO,�NTAL:IIEALTR,...W B1dgApp_2011.doc revised 06/21/11