B-2018-0059CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0059
20131 LAS ONDAS CT CUPERTINO, CA 95014-3106 (369 30 035) DIRECT HOMES
1721 ROGERS AVE
SAN JOSE 95112
OWNER'S NAME: CHENG PAUL C ET AL
OWNER'S PHONE: 650-400-0359
LICENSED CONTRACTOR'S DECLARATION
License Class @ Lic. #
Contractor DIRECT HOMES Date
1 hereby affirm that 1 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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
5 , 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.
Signature Date 1/09/2018
OWNER -BUILDER DECLARATION
I hereby affirm that 1 ant exempt from the Contractor's License Law for one of the
following two reasons:
1. 1, 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).
DATE ISSUED: 01/09/2018
PHONE NO: (885) 388-6695
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE (I1) WINDOWS, (1) SLIDING DOOR LIKE FOR LIKE;
SIDING ( SF) LIKE FOR LIKE
Sq. Ft Floor Area: I Valuation: $7000.00
APN Number: Occupancy Type:
369 30 035
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 01/09/2018
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Apl
Date: 1/09/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL
1. 1 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.
z. 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. I certify that in the performance of the work for which this permit is issued, 1
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. 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.
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.
Signature Date 1/09/2018
BE CLASS "A" OR BETTER
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. 1 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, and 25534.
Owner or authorized agent:
Date: 1/09/2018
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO CA 95014-3255
Imi (408) 777-3228 • building@cupertino.orQ PEMIT #B - Z U -
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION YALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
APN # D .-�5
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OWNER Nf
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STREET ADDRESS
CITY, STATE, ZIP
ONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER LICENSE
TYPE
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❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME E-MAIL
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DESCRIP'I'ON � _ hCi ( �
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INGLE-FAMTLY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
'$Q.FT.
VALUATION ($)
EXISTING USE
I EX 15MG SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODELOTHR GARAGE
❑ ATTACHED
BATHROOM SF
SF
SF SF
❑ DETACHED
lQnm
MUSING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION ❑ YES
FIRE SPRINKLERS ❑ NO
❑ NO
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED❑ DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF I SPA ATTACHED 0 YES ❑ NO I TOTAL - SF
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TOTAL VALUATION:
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department o(Environmental Heath GM[2al
L3_0 W11
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NOI
IF NO
PLYWOOD ❑'h" F]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 []ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES
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 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
to 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 acknowledge and authorize all information contained on this application form
to be made available for public record. I Q
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Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
BldgApp_2OI T doc revised 08101117
CONSTRUCTION PERMIT APPLICATION
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COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B'
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ,� Q
(408) 777-3228 • building@culertino.org PEMIT #B - ZO U
CUPERTINO I REV# DEFA
❑ NEW CONSTRUCTION ❑ ADDITION V ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWM M qG POOL/SPA
PROJECT ADDRESS
APN A
39- 3Z-035
OWNEPHONE
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E-MAIL
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STREET ADDRESS
I cny, STATE, ZIP
CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
%STREET
NAME L,IICENSS NUtvIBFj�� ^
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ADDRESS ' Av c,
C 5 C, CA ^ 57
E-MAIL PHONE /j ` BUST. LIC A
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❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CI Y, STATE, ZIP
PHONE
DES N ' tl r l V7S {�L ,
( wu�, Sr r
❑SINGLE-FAMILY/DUPLEX ❑MULTI -FAMILY ❑ INDUSTRIAL []COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXLSTING SF
NEW FLOOR SF
PORCH
SF DECK SF
I DEMO SF
I STORIES A
ITOTALNETSF
REN40DEL
REMODEL KITCHEN
REN40DELOTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF SF
❑ DETACHED
EXISING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION ❑ YES
FIRE SPRINKLERS ❑ NO
❑ NO
❑ NO
DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS A UNIT ADDITON: []NO S F
POOLS ❑ FIBERGLASS ❑ VLNYL-LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO I TOTAL - SF
Commercial or Multi-Fmnilu Buildings with Public Swimming Pools renuires Drnnrtment ofEm�irommOrtal Heath mmrn:wl
REC
LU.(�TIONT:
(%
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT -LT ROOF ❑ ASPHALT SHLNGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑ 'h ❑ 3/8"
PLYWOOD TYPE:
PITCH:
ROOF CLASS
ElYES
A OF LAYERS
I
THICK!,jESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
.12
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF :of SQUARES
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 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
to 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 acknowledge and authorize all information contained on this application form
to be made available for public r ord.
Signature of Applicant/Ag I Da L Y/ 18
SUPPLEMENTAL INFORNIA ION REQUIRED
*I\IeNv SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
"Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning 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