B-2017-0783 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0783
7570 SQUIREWOOD WAY CUPERTINO,CA 95014-5055(362 26 036) Z DESIGN
CONSTRUCTION INC
SAN JOSE,CA 95131
OWNER'S NAME: Chu Charles And Tsai Pei Chun DATE ISSUED:05/20/2019
OWNER'S PHONE: PHONE NO:(408)921-5044
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#1029660
Contractor Z DESIGN CONSTRUCTION INC Date 08/31/2019 X BLDG X ELECT _PLUMB
I 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:
1 ST FLOOR FRONT ADDITION TO CREATE NEW ENTRY,GUEST
I hereby affirm under penalty of perjury one of the following two declarations: BEDROOM,BATHROOM,UTILITY ROOM(497 S.F.);CREATE WALK
1. I have and will maintain a certificate of consent to self-insure for Worker's IN CLOSET FOR MASTER BEDROOM;REMODEL MASTER
Compensation,as provided for by Section 3700 of the Labor Code,for the BATHROOM SHOWER AREA(60 S.F.)
performance of the work for which this permit is issued. REV#I -UPGRADE MAIN PANEL-(200 AMP)-ISSUED 06/10/2019
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
A'Permit is issued. Sq.Ft Floor Area:497 Valuation:$183000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN
information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type:
362
and state laws relating to building construction,and hereby authorize 362 26 036 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 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-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/10/2019 Issued by:Haley McKee
Date:05/20/2019
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
1. 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. 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:06/10/2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
perfonnance 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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after snaking 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,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:06/10/2019
I certify that I have read this application and state that the above information is O TR TI LE I Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agenc 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. I understand my plans shall be used as public records.
Licensed
Signature Date 06/10/2019 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
t'` 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
• PERMIT#B 0
(408) ��7 3228 bulldln,�Ccupe��.no.or�
CV, PERTN REV# DEF#_�
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. MEP ❑RE-ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS a ,_ APN#
OWNER ME �:W1-J
'N PHONE E-MA_Q�6\1
IL
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STREET ADDRESS CITY, STATE,ZIP
r/
CONTRACTOR NAME E]OWNER-BUILDERCOMPANY NAME LICENSE NUMBER LICENSE TYPE
STREET ADDRESS` � � CITY,STA
E-MAIL PHONE BUS.LIC#
❑ARCHITECT ❑OWNER❑OWNER AGENT ❑CONTRACTOR AGENT❑ENGINEER❑DEVELOPER ❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTON E
v. L
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR 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 ❑A'TT'ACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F
POOLS ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED❑YES ❑NO TOTAL-SF
- CEIVED BY: TOTAL VALUATION:
Commercial or Multi-Fainily Buildings with Public Swimming Pools requires DQ2artmant of Environmental Heata
RE—ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO I IF NO PLYWOOD ❑1/2,i ❑3/8„ PLYWOOD TYPE: PITCH: ROOF CLASS
[DYES #OF LAYERS THICKNESS❑5/8" OTHER [:]OSB E]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 con ine on this application form
to be made available for public record.
Signature of Applicant/Agent: Date: 0
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.
WHOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08101/17