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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: .