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13100209 (3) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21351 VAI AVE CONTRACTOR:ALPS CONSTRUCTION& PERMIT NO:13100209 REMODELING OWNER'S NAME: PANG JASON L AND WUWANICH WOLALAK 1011 S DE ANZA BLVD DATE ISSUED:03/26/2014 OWNER'S PHONE: 4083099555 SAN JOSE,CA 95129 PHONE NO:(408)898-6474 V LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] CONSTRUCT 2 STORY DWELLING(4437 SQ FT)WITH License Class__ Lic.# 3 ATTACHED GARAGE(657 SQ FT); FRONT AND REAR ' i PORCHES(776 SQ FT). Contractor o � Co114/1 1 e:t Date REVISION#1-REVISE TRUSS CALCS-ISSUED 6/11/15 �-' � , V CSP I hereby affirm that I am licensed under the provisions of Ch pter 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: 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. Sq.Ft Floor Area: Valuation:$820000 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 APN Number:36205044.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORD IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS CALLED INSPECTION. 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 com ed by: Date: with all non-points rce regulations per the Cupertino Municipal Cod 9 18. RE-ROOFS: Signature -atefo All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ r_oy� R-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm at I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup rtino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5,25533,and 25534 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: ate: 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 CONSTRUCT �ENDINGAGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date CONSTRUCTION PERMIT APPLICATION law"_ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \� 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 \� (408)777-3228• FAX(408)777-3333- buildina(I)cuper ino.orq CUPERTINO ❑NEW CONSTRUCTION� {1 ❑ ADDITION [:] ALTERATION/TI REVISION/DEFERRB ORIGINAL PERMIT 9 PROTECT ADDRESS APN# oU,��' ` ��`. lJ J OWNERNAME �ji f PHONE E-MAIL STREET ADDRESS CITY, ST TE,ZI �Iif Q n y FAX X V 357 VAf Ate- CONTACT NAME ©�� PHONE E-MAIL STREET ADDRESS ' CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-Bu LDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /f (�GvL,Ccti LICENSE NUMBER AD ly 33 LICENSE TYPE BUS.LIC# COMPANY NAM�4///(V'111����"�{�GC E-MAILCJI ! (� ��� �L�� L e FAX STREET SS (�GGG le �� CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAI`4E LICENSE NUMBER f -c / BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTINGUSE PROPOSED USE CONST TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? [-]NO PRE PLICATION F-]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES _RECEIVED BY''i �' k +. + ' T AL VALUATION: PLANNING APPI, ❑NO PLANNING APPROVAL LETTER EICHLERHONIE? ❑NO Y By my signature below,I certify to each of the followi I a n 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 co ect. lave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu' ing cons ctio I authorize representatives of Cupertino to enter the above-i en ifi d pre for inspection purposes. Signature of Applicant/Agent: Date SUPPLE1,&1-KAL-INF0kMATI0N REQUIRED Rif New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER TaE COUNTER ❑ BUILvu.G PLANREVIEw r ; existing building(s). Demolition pen-nit is required prior to issuance of building k permit for new building. �'❑�"EXPRESSe ' � C��PL�1\INGPLANREVIE�Y� � � k PUBLIC4ORKS t+ _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STDARD form if any Hazardous Materials are being used as part of this project. ❑LEGE FIREDEPT c _Copy of Planning Approval Letter or Meeting with Planning prior to p47oR r �]�sANI.7�RYSEwEADISTRICTt submittal of Building Permit application. -° '❑ ENV.IROI�'MENTALAEAliTA, BldgApp_2 011.doe revised 06/21/11