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