B-2017-1078CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
20032 FOREST AVE CUPERTINO, CA 95014-2009 (316 23 107)120030 FOREST AVE
CUPERTINO, CA 95014-2009 (316 23 107)
CONTRACTOR:
PROGRESS BUILDERS
SAN FRANCISCO, CA
94115
PERMIT NO: B-2017-1078
OWNER'S NAME:
DATE ISSUED: 05/25/2018
OWNER'S PHONE: 650-996-7802
PHONE NO: (650) 331-2828
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
X BLDG _ ELECT _ PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
LOT A (N) TWO STORY SFD (4982 SF); ATTACHED GAR (645 SF);
PORCH (3) (671 SF); ATTACHED 2ND UNIT (475 S.F.)
# 1 - REVISE STANDARD HVAC SYSTEM AND IMPLEMENT (3)
MULTI -ZONES MINI SPLIT FOR ENTIRE HOUSE-REV#1 ISSUE 9-10-
2018
License Class B Lic. #917649
Contractor PROGRESS BUILDERS Date 06/30/2018
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.
I hereby affirm under penalty of -perjury one of the following two declarations:
1.11 have and will maintain a certificate of consent to self -insure for Worker's =4REV
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
Sq. Ft Floor Area: 5457
Valuation: $800000.00
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, j ogments, costs, and expenses which
may accrue against said City in co-quence of the granting of this permit.
Additionally, the applicant unders . is and w' ' omply with all non -point
source regulations per the Cup, o Muni '... Code, Section 9.18.
Signature
Date: 05/25/2018
All roofs shall be inspected
installed without first obtaining
Signature of Applicant:
RE -ROOFS:
I hereby affirm that I . r exempt from the Contractor's License Law for one of the
following two reasons:
1. I, 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).
I 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
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
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, I
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
prior to any roofing material being installed. If a roof is
an inspection, I agree to remove all new materials for
inspection.
Date: 9-10-2018
TO BE CLASS "A" OR BETTER
ALL ROOF COVERINGS
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous
California Health & Safety
maintain compliance with
Health & Safety Code,
material. Additionally, should
air contaminants as defined
will maintain compliance
the Health & Safety
Owner or authorized agent:
Date: 9-10-2018
materials requirements under Chapter 6.95 of the
Code, Sections 25505, 25533, and 25534. I will
the Cupertino Municipal Code, Chapter 9.12 and the
Section 25532(a) should I store or handle hazardous
I use equipment or devi . which emit hazardous
by the Bay Area Air Qu : r Manage I It District I
with the Cupertino Mull' ip . Code, , , ter 9.12 and
!�
_�'
TR TI • N LE ► DIN A N Y
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 9-10-2018
• h..
I hereby affirm that there is a constructs.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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
20032 FOREST AVE CUPERTINO, CA 95014-2009 (316 23 107)120030 FOREST AVE
CUPERTINO, CA 95014-2009 (316 23 107)
CONTRACTOR:
PROGRESS BUILDERS
SAN FRANCISCO, CA
94115
PERMIT NO: B-2017-1078
OWNER'S NAME: Chiu Raymond K T And Adeline Y H Trustee
DATE ISSUED: 05/25/2018
OWNER'S PHONE: 650-996-7802
PHONE NO: (650) 331-2828
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
X BLDG _ ELECT _ PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
LOT A (N) TWO STORY SFD (4982 SF); ATTACHED GAR (645 SF);
PORCH (3) (671 SF); ATTACHED 2ND UNIT (475 S.F.)
REV # 1 - REVISE STANDARD HVAC SYSTEM AND IMPLEMENT (3)
MULTI -ZONES MINI SPLIT FOR ENTIRE HOUSE-REV#1 ISSUE 9-10-
2018
rev # 2 - CHANGES TO MECHANICAL, PLUMBING, ELECTRICAL,
NEW SKYLIGHTS; RELOCATE WATER HEATER - ISSUED 4-5-2019
License Class B Lic. #917649
Contractor PROGRESS BUILDERS Date 06/30/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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
performance of the work for which this permit is issued.
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.
APPLICANT CERTIFICATION
Sq. Ft Floor Area: 5457
Valuation: $800000.00
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, jud ents, costs, and expenses which
may accrue against said City in cons quence of the ranting of this permit.
Additionally, the applicant understa ds phd will �erfiply)with all non -point
source regulations per the Cup o icip�t`Code.rsection 9.18.
e
Signature .; Date 4-5-2019
APN Number:
31623 112
Occupancy Type:
R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
OWNER -BUILDER DE - I ARATI N
Date: 05/25/2018
All roofs shall be inspected
installed without first obtaining
Signature of Applicant:
RE -ROOFS:
I hereby affirm that I a exempt from the Contractor's License Law for one of the
following two reasons/
1. I, as ownel f 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).
I 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
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
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, I
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
prior to any roofing material being installed. If a roof is
an inspection, I agree to remove all new materials for
inspection.
Date: 4-5-2019
TO BE CLASS "A" OR BETTER
ALL ROOF COVERINGS
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous
California Health & Safety
maintain compliance with
Health & Safety Code,
material. Additionally, should
air contaminants as defined
will maintain compliance
the Health & Safety
Owner or authorized ag
Date: 4-5-2019
materials requirements under Chapter 6.95 of the
Code, Sections 25505, 25533, and 25534. I will
the Cupertino Municipal Code, Chapter 9.12 and the
Section 25532(a) shout store or handle hazardous
I use equipme or d vices which emit hazardous
by the Bay Are Air Q ality Management District I
with the Cuperti o Mu 'Icipal Code, Chapter 9.12 and
Code,.Secti s 2 25533, and 25534.
t:
LENDING AGENCY
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 4-5-2019
CONSTRUCTION
I hereby affirm that there is a cons uction 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 .
BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING
OWNER'S NAME: CHIU RAYMOND K T AND ADELINE Y H TRUSTEE
OWNER'S PHONE: Not Provided
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 2/5/2020 12:07:22 PM
ISSUED BY: HALEYM
VALUATION: $800000
JOB DESCRIPTION
LOT A (N) TWO STORY SFD (4982 SF); ATTACHED GAR (645 SF); PORCH
(3) (671 SF); ATTACHED 2ND UNIT (475 S.F.) REV # 1 - REVISE STANDARD HVAC SYSTEM AND IMPLEMENT (3)
MULTI -ZONES MINI SPLIT FOR ENTIRE HOUSE-REV#1 ISSUE 9-10-2018 rev # 2 - CHANGES TO MECHANICAL, PLUMBING, ELECTRICAL, NEW SKYLIGHTS; RELOCATE WATER HEATER - ISSUED
4-5-2019 REV # 3 - ADD NEW GAS LINE, SEWER LINE, AND WATER LINE FOR FUTURE BBQ AND OUTDOOR SINK AT REAR - ISSUED 2/5/2020
OWNER -BUILDER DECLARATION
I hereby affirm under penatly of perjury one of the following two declarations:
I, as owner of the property, or my employees with wages as their role compensation, will do the work, and the structure
is not intended or offered for sale (Sec. 7044, Business &
Professions
Code).
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professions Code).
V
I hereby
affirm under penatiy of perjury one of the following two declarations:
V
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.
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.
I certify that in the performance of the work for which this permit is issued, I 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.
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. I will maintain compliance
V
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.
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified
Firm Name:
Firm Certification No:
v
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby
affirm
under penalty of perjury that there is a construction
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes
V
No
Lender's
Name:
Lender's Address:
APPLICATION 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, judgements, 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:
.