B-2017-1078 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1078
20032 FOREST AVE CUPERTINO,CA 95014-2009(316 23 107)120030 FOREST AVE PROGRESS BUILDERS
CUPERTINO,CA 95014-2009(316 23 107) SAN FRANCISCO,CA
94115
OWNER'S NAME: DATE ISSUED:05/25/2018
OWNER'S PHONE: PHONE NO:(650)331-2828
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#917649
Contractor PROGRESS BUILDERS Date 06/30/2018 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
LOT A(N)TWO STORY SFD(4982 SF);ATTACHED GAR(645 SF);
I hereby affirm under penalty of perjury one of the following two declarations: PORCH(3)(671 SF);ATTACHED 2ND UNIT(475 S.F.)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -REVISE STANDARD HVAC SYSTEM AND IMPLEMENT(3)
Compensation,as provided for by Section 3700 of the Labor Code,for the MULTI-ZONES MINI SPLIT FOR ENTIRE HOUSE-REV#1 ISSUE 9-10-
performance of the work for which this permit is issued. 2018
2. I have and will maintain Worker's Compensation Insurance,as provided for by rev#2-CHANGES TO MECHANICAL,PLUMBING,ELECTRICAL,
, Section 3700 of the Labor Code,for the performance of the work for which this NEW SKYLIGHTS;RELOCATE WATER HEATER-ISSUED 4-5-2019
' permit is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area:5457 Valuation:$800000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31623 112 R-3(Custom)
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 I
may accrue against said City in cons quence of the ranting of this permit. SNOT STARTED
Additionally,the applicant understa 11ds end Will, a ply;'with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations .,,Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signaturey-' Date 4-5-2019 Issued by:Abby A ey nde
Date: 05/25/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I a' 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 ownef 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:4-5-2019
1 hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 l.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. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)shout L, tore or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipme or dvices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Are Air Q��ahty Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Mu,"Icipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall
APPLICANT CERTIFICATION Date:4-5-2019
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 cons uction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is' sued(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. 1 understand my plans shall be used as public records.
Signature Date 4-5-2019 Licensed
Professional
` CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1078
20032 FOREST AVE CUPERTINO,CA 95014-2009(316 23 107)120030 FOREST AVE PROGRESS BUILDERS
CUPERTINO,CA 95014-2009(316 23 107) SAN FRANCISCO,CA
94115
OWNER'S NAME: CHIU RAYMOND K T AND ADELINE Y H TRUSTEE DATE ISSUED:05/25/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#917649
Contractor PROGRESS BUILDERS Date 06/30/2018 X BLDG _ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
LOT A(N)TWO STORY SFD(4982 SF);ATTACHED GAR(645 SF);
I hereby affirm under penalty of.perjury one of the following two declarations: PORCH(3)(671 SF);ATTACHED 2ND UNIT(475 S.F.)
t.lFI have and will maintain a certificate of consent to self-insure for Worker's EV#1-REVISE STANDARD HVAC SYSTEM AND IMPLEMENT(3)
Compensation,as provided for by Section 3700 of the Labor Code,for the MULTI-ZONES MINI SPLIT FOR ENTIRE HOUSE-REV#1 ISSUE 9-10-
performance of the work for which this permit is issued. 2018
2. 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. Sq.Ft Floor Area:5457 Valuation:$800000.00
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 31623 112 R-3(Custom)
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,j gments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in co s quence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant unders s and w' omply with all non-point
source regulations per the Cup o MunicM Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
�
Signature Date 9-10-2018 Issued by:Abby Ayende
OWNER-BUILDER— T/N Date:05/25/2018
DE ARA
I hereby affirm that I t 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
t. 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9-10-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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. 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 devi which emit hazardous
air contaminants as defined by the Bay Area Air Qu Manage t District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Muni ip Code, ter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 255 5, 533,a 534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9-10-2018
I certify that I have read this application and state that the above information is CONSTRUCI Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constructilending 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. 1 understand my plans shall be used as public records.
Licensed
Signature Date 9-10-2018 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2017-1078
20032 FOREST AVE CUPERTINO,CA 95014-2009(316 23 107)120030 FOREST AVE PROGRESS BUILDERS
CUPERTINO,CA 95014-2009(316 23 107) SAN FRANCISCO,CA
94115
OWNER'SNAME:CHID RAYMOND K T AND ADELINE Y H TRUSTEE DATE ISSUED:05/25/2018
OWNER'S PHONE: PHONE NO:(650)331-2828
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#917649
Contractor PROGRESS BUILDERS Date 06/30/2018 X BLDG ELECT_PLUMB
I hereby nl'flrm that 1 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 fall force and effect. JOB DESCRIPTION:
LOTA(N)TWO STORY SFD(4982 SF);ATTACHED GAR(645 SF);
I hereby affirm under penalty of perjury one of the following two declarations: PORCH(3)(671 SF);ATTACHED 2ND UNIT(475 S.R)
r. 1 have and will maintain a certificate of consent to sclf-insurc 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.
1 have"nd will maintain Worker's Compeosatimn Insnranoe,as provided for by
Scctio3700 of the Labor Code,for the performance of the war k for which this
permit is issued Sq.Ft Floor Area:5457 Valuation;,$800000.00
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 MIN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31623 107 R-3(Custom)
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 WORE{IS NOT STARTED
may accrue against said City In cons uence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant underst fP and will comply with all non-point
source regulations per the Cupe unicipal Cod ,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5/25/2018 Issued by:Abby Ayende
Date:05/25/2018
OWNER-B ILDER CLARA I
1 hereby air,,.,that I am exempt from the Contractor's License Law t'nr one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
n 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered Por inspection,
sale(Sue 7044,Business&Professions Cade)
i. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplieane
contractors to construct the project(Sec.7044,Business&Professions Cade). Date:5/25/2018
I hereby affirm under penalty ofperjury,one of the following three dechmations: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTERt. I have and will maintain a Certificate of Consent to self-inswn for Wod<ei's
Compensation,as provided for by Section 3700 of the Labor Code,for tine
perfarmance fthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements undo Chapter 6.95 or the
.Section 3700 of the Labor Code,for the performance of the work for which this Calf£arnfa Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with Bre Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,l health&Safety Code,Section 2S532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should 1 use equipment er dev'e.which emft hazardous
ontnminants as defined by the Bay Area Air Qa Iffy Management District I
Worker's Compensation laws of California.[f,after making this eertigoale of will maintain compliance with the Cupertino Me c'pal Code,Chapter 9.12 and
exemption,I become subject to the Worli Compensation provisions of the the Health&Safety Code,Sections 25 33,mud 5534.
Labor Code,1 must forthwith comply with such provisions or this permit shall _
be deemed revoked. Owner or authorized agent:
APPI,ICAN'I'CERTIFICATION Date:5/25/2018
I certify that I have read this application and state that the above information is CONSTRU TI L ING A,EN Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constructn 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 AItCHI'I'ECT'S DECLARA'T'ION
Code,Section 9.18. 1 understand my plans shall be used as public records. -
SignatureLicensed
Date 5125/2018
Professional