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B-2017-2090
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2090 19915 PRICE AVE CUPERTINO,CA 95014-3338(369 05 043) HOME DEPOT U S A INC ATLANTA,GA 30339 • OWNER'S NAME: CHIU HUIWEN TRUSTEE DATE ISSUED: 12/06/2017 OWNER'S PHONE:408-489-9772 PHONE NO:(770)433-8211 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-17 Lic.#602331 . Contractor HOME DEPOT U S A INC Date 09/30/2018 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: REPLACE WINDOW(1)IN LIVING ROOM-LIKE FOR LIKE 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. 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. . Ft Floor Area: Valuation:$1672.00 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 05 043 . 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. Signature IIIPIPPDate 12-06-2017 Issued by:Kim Dunbar l �� Date: 12/06/2017 e A ►ER-B I D ' DE LSI UEI' 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:12-06-2017 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 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 or authorized agent: ��— APPLICANT CERTIFICATION Date: 12-06-2017 I certify that I have read this application and state that the above information is I!= 41" NGGE ANCY 4111.— correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that th-re is a co ruction 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 12-06-2017 Professional / CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ,.......„ ri, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ge .s (408) 777-3228 • building@cupertino.org PEMIT#B-1_0 .1- - `L.cCk. 0 CUPERTINO ❑ NEW CONSTRUCTION ❑ADDITION It ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS I C9i p,_ 6,--' G6,-- /3-01:-: APN# Co l - C) 5-oL 3 OWNER NAME I . PHONE E-MAIL AIA-1r-FA,) C-f-Fo(.) qv-ea •.fig 9•?77Z STREET ADDRESS CITY, STATE,ZIP 1 9 Cr 1; P�Ic .� A-)( c- rr1,Jo ` c A So/ CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE 440PVI C LDN7 7 1) , 60Z331 7, I7 I STREEI ADDRESSCITY STATE,ZIP 2,456 I)i-,2-1J�- Com_ ' jel-,kl LEA-A)b ) I G• A 9zf577 E-MAIL PHONE BUS.LIC# QEF-rarK_ 2ft-.-A)r( ( A-r-r_,JE'T SID• g77' `-I55o 4 o3` ' 0 ARCHITECT 0 OWNER ❑OWNER AGENT 1RCONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME , 7A-fnJ,r TE R-E„ - /Frn)F� A-7-7.,JE 7 STREET ADDRESS CITY, ATE,ZIP PHONE lO b q E%>'m&-- L-A) 9f4-Y 0A-p-7), C-A 71.{-5,/ 5/e, -.427-42..6 6 DECRIPTON I d s- r l ©AJ e— --e-Fr(k = ,�-7 � f,J DOS l ,i it ti t,o3 , 1 - . `SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED ' BATHROOM SF SF SF SF 0 DETACHED FIRES RG INKLERS 0 YESO EICHLER ❑❑ ES SECOND STORYADDmON 0 O 0 O DWELLING SECOND DWELLING 0 YES 0 ATTACHED DETACHED OTHER , UNTIE# UNIT ADDITON: ❑NO S F POOLS' 0 FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED POOL-SF SPA-SF SPA ATTACHED 0 YES 0 NO TOTAL-SF - • EIVED BY: TOTAL VALUATION: 4,1,...„....._ n / Commercial or Multi-Faintly Buildinxs with Public Swimming Pools requires Department Environmental Heath approval S e ..ai RE-ROOFI EXISTING ROOF TYPE: [IBUILT-UPROOF❑ASPHALT SHINGLES WOOD SHAKES❑ OOD SHINGLES❑TILE OTHERI(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD ❑W' ❑3/8” PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES B 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 WI 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 inspection purposes. I acknowled_•e and authori • - '-.. • ..on contained on this application form tol,bemadeavailableforpublicrecord. `Zf- 7'r ,1 Signature of Applicant/Agent: i Date: I__ t/ _ SUPPLEMENTAL INFORM' ION t �:lIRED *New SFD/Second Dwellin• s/Multifamily Dwellin,:.A Dem. '-.in permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a1 completed Haza .ous --- ials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting . ning 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