BLD-2020-19805/28/2021
CITY OF CUPERTINO BUILDING PERMIT
BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
W W W.CUPERTINO.ORG
BUILDING ADDRESS: 1171 CRESTLINE DR Cupertino
APN: 362 29 040
PERMIT NO: BLD-2020-1980
OWNER'S NAME:
CONTRACTOR: TONY TRAN CONSTRUCTION, 3591 COUR DE CHARLES SAN JOSE CONTRACTOR PHONE:
DATE ISSUED 5/28/2021 1:57:56 PM ISSUED BY: KDUNBAR VALUATION: $180000
JOB DESCRIPTION
(N) 2ND STORY ADDITION (662 SF) (MASTER BEDROOM, BATH, PRAYER & LOUNGE); (N) 2ND STORY BALCONY (147 SF); (N) 1ST STORY ADDITION (16 SF) @ FRONT ENTRY; (N) 1ST STORY
COVERED PORCH (92 SF); REMODEL KITCHEN (260 SF); REMODEL 1ST FLOOR BATHROOMS (90 SF); REMODEL OTHER (1,284 SF); (N) FURNACE ATTIC (2ND FLOOR); REPLACE FURNACE (1ST
FLOOR); (N) OUTDOOR A/C UNIT; FULLY SPRINKLER BUILDING; REPLACE ALL EXISTING DUCT WORK; RELOCATE WASHER AND DYER; NEW TANKLESS WATER HEATER; NEW EV CHARGING
STATION;
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: TONY TRAN CONSTRUCTION LICENSED CLASS:
B GENERAL BUILDING COI
LICENSED NO: 864465
EXP DATE:
09/30/2021
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 penatly of perjury one of the following three declarations:
ElI 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.
EI 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
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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 with the
rCupertino 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.
EPA LEAD -SAFE DISCLOSURE
ElAn EPA Lead -Safe Certified Renovator will be responsible for this project.
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Certified Firm Name:
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No EPA Lead -Safe Certified Firm is required for this project.
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Firm Certification No: u
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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).
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Lender's Name::
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Lender's Address:
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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:
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 365
days after the time the work is commenced.
Submit
https://apps.cupertino.org/Accela/BLD-Sign-Permit.aspx?AccelaUser=ONETIMESIGN&OTK=kXDyyjCsWrmw4poYnVfaEL8pFgtKrTDZOMZXzWjxgTO... 1/1