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B-2017-2041CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-2041 Ll OS VERDES DR CUPERTINO, CA 95014-4723 (356 20 040) YUANLONG 7 CONSTRUCTION INC 1'( i `u ROSEMEAD, CA 91770 OWNER'S NAME: OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class 3 Lic. # 27q Contractor YUANLONG CONSTRUCTION INC Date 04/30/2018 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. hereby'affirm•under penalty of perjury one of the following two declarations: i. , 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 &IPformance of the work for which this permit is issued. 4jam' 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. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 1215/2017 • ._•N1111130111WAN A.11 •► I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: i. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec,7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: i. 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. 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. 3. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ISSUED: 12/05/2017 PHONE NO: ( BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL — COMMERCIAL JOB DESCRIPTION: MASTER BEDROOM REMODEL(100 S.F); KITCHEN REMODEL (170 S.F.) INCLUDES INSTALLATION OF SUPPORT BEAMS; CONVERT 2ND FLOOR LOFT TO BEDROOM (134 S.F.); REMOVE CLOSETS LOFT AREA WITH INSTALLATION OF CEILING BEAM (74 S.F.); ADD UTILITY SINK IN GARAGE. Sq. Ft Floor Area: Valuation: $30000.00 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 and state laws relating to building construction, and hereby authorize 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, arid expenses which may accrue against said City in consequence of the granting "of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal CodeiISection 9.18. Date12/512QIZ APN Number: Occupancy Type: 356 20 040 1 l PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Archbold Date: 12/05/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed.,If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 12/5/2017 "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, an? Ow ` Ow authorized agent:��� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2017-2041 11126 PALOS VERDES DR CUPERTINO,CA 95014-4723(356 20 042) YUANLONG CONSTRUCTION INC ROSEMEAD,CA 91770 OWNER'S NAME: DATE ISSUED;12/05/2017 OWNER'S PHONE:408-666-5327 PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#1012793 Contractor YUANLONG CONSTRUCTION INC Date 04/30/2018 X BLDG X ELECT X PLUMB 1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MASTER BEDROOM REMODEL(100 ST);KITCHEN REMODEL(170 I hereby affirm under penalty of perjury one of the following two declarations: S.F.)INCLUDES INSTALLATION OF SUPPORT BEAMS;CONVERT t. I have and will maintain a certificate of consent to self-insure for Worker's 2ND FLOOR LOFT TO BEDROOM(134 S,F,);REMOVE CLOSETS Compensation,as provided for by Section 3700 of the Labor Code,£or the LOFT AREA WITH INSTALLATION OF CEILING BEAM(74 S.F.); peniormance of the work for which Ibis permit is issued. ADD UTILITY SINK IN GARAGE. I have and will maintain Worker's Compensation I surance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this REV 92:REVISE ELECTRICAL LIGHTING LAYOUTAND OUTLETS. permit is issued. ISSUED 3.30.18 APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$30000.00 1 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 and state laws relating to building construction,and hereby authorize APN Number: Occupancy TlTa,: representatives of this city to enter upon the above mentioned property for 356 20 042 inspection purposes.(We)agree to save Indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature _ / /Date x,30.18 Issued by:SEAN I-IATCI-I OWNER-BUILDER DECLARATION Data;1ZM5/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: r. 1,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is compensation,will do the work,and the structure is not Intended or offered for installed without first obtaining ann nspection,I agree to remove all new materials for sale(Sec,7044,Business&Professions Code) inspection. x. 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7044,Business&Professions Code). Signature o£Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date'3.30 l8 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER performance of die work for which this permit is issued. I I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6,95 of the permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534.1 will 3. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Caperthe,Municipal Code,Chapter 9.12 and the Shall not employ any person in any manner so as to become subject to the Health&Safety Code,Section 25532(a)should I store a-handle hazardous Worker's Compensation laws of California. If,after making this certificate of material.Additionally,should I use equipment or devices which emit hazardous exemption,I become subject to the Worker's Compensation provisions of the air contaminants as dented by the Bay Arca Air Quality Management District I Labor Code,I must forthwith comply with such provisions or this permit shall will ma Intel.compliance with the Cupertino Municipal Code,Chapter 9.12 and be deemed revoked, the Hoalth&Safety Code,Secxt—l/—2555005,22555333,and 25534. APPLICANT CERCI FICATION Owner or authorized agent: I certify that I have read thisapplication and state that the above information Is Date:3.30.18 correct.I agree to comply with all city and County ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction,and hereby authorize representatives of this city I hereby affirm that there Is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We)agree of work's for which this permit Is Issued(Sec.3097,Civ C) to save Indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name Judgments,costs,and expenses which may accrue against said City In consequence of the granting of this permit.Additionally,the applicant understands Lender's Address and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ARCHI'TECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 3 30.18 Licensed Professional