B-2016-2415 Rev#1CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2415
20727 RODRIGUES AVE CUPERTINO, CA 95014-2964 (359 10 059)
JEREMY MAO INC
SARATOGA, CA 95070
OWNER'S NAME: LI XIAOCHUN AND ZHANG XIN
DATE ISSUED: 02/02/2017
OWNER'S PHONE:
PHONE NO: (408) 449.9942
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. #813452
Contractor JEREMY MAO INC Date 10/31/2018
x BLDG _ELECT _PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
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.
JOB DESCRIPTION:
CONSTRUCT (N) 2 STORY SFD (3,791 S.F.); ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
(412 S.F.); PORCHESBALCONIES/DECKS (700 S.F.)
1. 1 have and will maintain a certificate of consent to self -insure for Worker's
REV #1 - REMOVE CRAWL SPACE ACCESS AND FOUNDATION
Compensation, as provided for by Section 3700 of the Labor Code, for the
VENT, REMOVE PATIO DOOR; NEW LAYOUT FOR LAUNDRY
performance of the work for which this permit is issued.
ROOM; BEDROOM 2 - CLOSE OFF SIDE WINDOW; BEDROOM 1 & 2
z. I have and will maintain Worker's Compensation Insurance, as provided for by
- CONSTRUCT (N) WINDOW; BATHROOM #1 - CHANGE TUB TO
Section 3700 of the Labor Code, for the performance of the work for which this
SHOWER; SWITCH TOILET AND SINK; CHANGE OPENING ABOVE
permit is issued.
THE DECK FROM 6 TO 4 - ISSUED 1-16-2018
Sq. Ft Floor Area: 4203
Valuation: $650000.00
APPLICANT CERTIFICATION
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
representatives of this city to enter upon the above mentioned property for
359 10 059
Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U
inspection purposes. (We) agree to save indemnify and keep harmless the
(Private Gar / Ag Bldg),U (Private Gar / Ag Bldg)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
source regulations per the Cupertino Municipal Code, Section 9.18.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature Date 01-16-2018
180 DAYS FROM LAST CALLED INSPECTION.
OWNER -BUILDER DECLARATION
Issued by: Abby Ay&nde
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Date: 02/02/2017
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
RE -ROOFS:
compensation, will do the work, and the structure is not intended or offered for
All roofs shall be inspected prior to any roofing material being installed. If a roof is
sale (Sec.7044, Business & Professions Code)
installed without first obtaining an inspection, 1 agree to remove all new materials for
z. I, as owner of the property, am exclusively contracting with licensed
inspection.
contractors to construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations:
Signature of Applicant:
Date: 01-16-2018
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.
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
s. 1 certify that in the performance of the work for which this permit is issued, I
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Worker's Compensation laws of California. If, after making this certificate of
Health & Safety Code, Section 25532(a) should I store or handle hazardous
exemption, I become subject to the Worker's Compensation provisions of the
material. Additionally, should I use equipment or devices which emit hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall
air contaminants as defined by the Bay Area Air Quality Management District I
be deemed revoked.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
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
Date: 01-16-2018
relating to building construction, and hereby authorize representatives of this city
CONSTRUCTION LENDING AGENCY
to enter upon the above mentioned property for inspection purposes. (We) agree
I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities,
of work's for which this permit is issued (Sec. 3097, Civ C.)
judgments, costs, and expenses which may accrue against said City in
Lender's Name
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Lender's Address
Code, Section 9.18.
ARCHITECT'S DECLARATION
Signature Date 01-16-2018
1 understand my plans shall be used as public records.
Licensed
Professional