B-2018-0980 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0980
10218 PARK CIRCLE EAPT 2 CUPERTINO,CA 95014-1958(326 32 008) OWNER/BUILDER
OWNER'S NAME:TANG ERIC CHENG LUN AND EVELYNE WU YIN TRUS DATE ISSUED:06/08/2018
OWNER'S PHONE;650-888-0868 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor OWNER/BUILDER Date XBLDG_ELECT XPLUMB
I herebyaffirm that I an licensed under the ns of Chapter 9 commenchi —MECH X RESIDENTIAL—COMMERCIAL
provisions p ( g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
NEW TANICLESS WATER HEATER SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
n. 1 have and will maintain a certificate ofcousent 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. Sq.Ft Floor Area: Valuation:S1500,00
APPLICANT CF.RT[FICATION
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 326 32 008
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-paint
source regulations per the Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/08/2018 Issued by:Kim Dunbar
Date:06/08/2018
OWNER-BUILDER DECLARATION
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
t. 1,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 wonk,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
e. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code). Date:06/08/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have and will maintain a Certificate of Consent to seif-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
/Q performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
liJ{jJ 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials rerem
quients order Chapter 6.95 of the
IJP Section ens
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
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(.)should I stare ar 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 endt hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
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,Se liens 25505,25533 nd 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall G/
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data:06/08/2018
I certify that I have read this application and state that the above Information Is CONSTRUCTION AGE,//,
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending age cy 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 sourc regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18 understand my plans shall be used as public records.
Licensed
Signature Date 06/08!2018 professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• building@cupertino.org PEMIT#B- 2U OeI
CUPERTINO f// REV# DEF#
[_1 NEW CONSTRUCTION ❑ADDmON ❑,! ALTERATION[:1 T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS /04,6 L
'` C�k /1`e..� \ APN tl ^ LTJ
OWNER NAME (/ K �,PtyI�E 1\T JE-MAIL U TV's
7 Ste $ sseJeC� e wd&e�xca�t�
STREET ADDRESS Sl`/��ye � CITY„STMlAT�E,,ZI p r"
D CONTRACTOR NAME } OWNER-BUILDER COMPANY NAME (1/dvAl W KLICENSE NUMBER LICENSE TYPE
STREET ADDRESS CITY,STATE,ZIP
E-MAIL PHONE BUS.LIC I
❑ARCIi1TECT ❑OWNER D OWNER AGENT ❑CONTRACTOR AGENT[]ENGINEER D DEVELOPER D TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTON TWl (` 5 (,/rt Ato jJtAjt^
DSINGLE-FAMILY/DUPLFX 964ULTI-FAMILY ❑INDUSTRIAL D COMMERCIAL
EXISTING CIE EXISTING SF NEWFLOORSF PORCHSF DECKSF DEMOSP STORIESA TOTALNETSF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE D ATTACHED
BATHROOM SF Sr Sr SP D DETACHED
EXIBINC ❑YES gICHEHR DYES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS D NO [I NO El NO
DWELLING ISECOND DWELLING DYES❑ATTACHED[]DETACHED OTHER
UNITS# UNIT ADDTI'ON: ❑NO S F
POOLS ❑FIBERGLASS D VINYL-LINED ❑GUNITE D PREFABRICATED
POOL-SF SPA-SF SPA ATIACIIRD AYES ❑NO TOTAL-SF
RECEN .-BY: TOT L VAL A'(JON:
C,mau:rcial,,MWti-Family Buildinsswi0,PubF,Swin,mine Pools requires Depart-1 dESN ,mW HeathnVp l l//1
!E100J EXISTING ROOF TYPE: ❑BUILT-UPROOT❑ASPHALT SHINGLES[-]WOOD SHAKES[]WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO I IF NO ❑3/B" PLYWOOD TYPE: PITCH: ROOP CLASS
[-1 YES IOFLAYERS 'THICKNESSQ5/8" OTHER ❑OSB L]COX OTHER ,12 A
PROPOSED ROOFTYPE:[)BUILT-UP ROOF DASPHALT SHINGLES[]WOOD SHAKES DWOODSFENGLES DOTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF dof 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 forpr ins - 'on es. c mwledge and authorize all information contained on this application form
to be made available for public record. —
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demoliti n 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
BldgA13h2017.doe revised 08101117