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B-2016-2269
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2.016-2269 20075 BOLLINGER RD CUPERTINO,CA 95014-4532(369 34 003) JEFF L YANG SARATOGA,CA 95070 OWNER'S NAME: STEWARDS OF THE CHURCH DATE ISSUED:10/0712016 OWNER'S PHONE:415-518-9698 PHONE NO:(408)439-9732 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic.#1014072 Contractor,JEFF L YANG Date 05/31/2018 X BLDG —ELECT —PLUMB _ I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: T.I.-CONVERT PORTION OF(E)SUNROOM TO(N)WOMEN I hereby affirm under penalty of perjury one of the following two declarations: RESTROOM;UPGRADE(E)MEN'S RESTROOM TO ACCESSIBILITY 1. I have and will maintain a certificate of consent to self-insure for Worker's 434 S.F. 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. Sq.Ft Floor Area Valuation:$50000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 34 003 A(Tenant Improvements) 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 f r Date 10-7-2016 Issued by:Kim Dunbar Date:10/07/2016 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) �—J 2. I,as owner of the property,am,exclusively contracting with licensed Signature of Applicant: contractors to construct the project(See.7044,Business&Professions Code). Date:10-7-2016 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 performance 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 a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making 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. wn gwner-or authorized agent: APPLICANT CERTIFICATION Date:10-7-2016 certify that l have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency 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 Abe . d RATION Code,Section 9.18. I understand my plans shhallall be used as public records. Licensed Signature Date 10-7-2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVIP," Jul10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPE� lam"fir „ {408)777-3226•FAX(408)777-3333•buildinq(akuperkiho.o,x 3- ZU1.6 -22 5 ❑NEW CONSTR.. TIOyN,f ❑ ADDITrION ff~ALTERATION/TI [I REVISION/DEFERRE'iD��j ORIGINAL PERMIT# PROJECT ADDRESS- 2 F t7 f 1. -gDLt_,--L s R cp. - 7APN t _-. . ✓ f QV� OWNERNAME L� - .. PHol E-MAIL TA- STREET ADDRES �' oZcrC6 Elm CITY,STATE,ZIP 6490 , FAX CONTACT NAME 1,8,4 T e PFI N$ E- ASL STREBTADDRESS L CITY,STATE,ZIP F ew4e-q 'CSP';, ❑OWNER Q.OWNER-BUILDER El OWNER C1CONTRACTOR ❑CONTRACTOR AGENT ElARCHITECT . ��1 ENGINEER ❑ DEVELOPER ❑TENANT ' CONTRACTORNAME ® LICENSENUMBF.R C7_2LICENSE TYPE BUS.LI zt-bq4(I COMPANY NAME ` l e �/'� IL C\D u_p ,C0iJ�, FAX STREETADDRESS BVtj,O(C&eve . C;t. CITY,STATE,ZIP `F14/� ti ny PHONE �f 't13�.g73L YVL ( t ARCHITECTIENGINEERNAMIt y6c LIC ENSENUMBER .iE j1a BUS,LIC# COMPANY NAME r' J �• PA FAX STREET ADDRESSCITY,STATE,ZIP PHONE 3 (r)-2 7t2.j EXISTING USE PROPOSED USE CONSTR.TYPE 1i STORIES Q T tt o USE TYPE occ. SQ.FT, VALUATION($) ExISTG r7 NEW FLOd '�1 DEMO TOTAL AREA AREA AREA NETAREAif 7 BATHROOM KITCHEN OTAER REMODELAREA 3 451 REMODELAREA REMODELAREA PORCH AREA DECKAREA 7LDECK(PDRCHARTA GARAGF.AREA: ❑DETACH- - ❑ATTACH #DWFLLINGUNITS: - 'IS.AMCONDUNIT ©YES SECONDSTORY - ❑YES - - BYINGADDED? []NO ADDITION? [:]No PRE-APPLICATION DYES IF YES,PROVIDE COPY OF ISTREELDGAN E]YES ;,R.ECEIkE ;_}t,:;i:;;;_t*:::"[,' `.F ;i`.� �;;� TOTALVALUATION: PLANNING APPLW ❑NO PLANNING APPROVAL LETTER EICIILER HOME? l]NO - 0 CW By my signature below,I certify to each of the following: I ani the property owner or authorized agent to act on the pr perly owner's behalf. I bave read tbis application and the information I have provided is cglrQct.I have read the Description of Work and verify it is accurate. l agree to comply with.all applicable local ordinances and state laws relating to building const) et n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signatur'cofAppiicantlAgent: Date: 7-6-1-6 . SUPPLEMENTAL INFORMATION REQUIRED ,. ..pL.N. X _New SFD or Multifamily dwellings: Apply for demolition permit for Q O�ER IHE COUNTER ILDIAGPLAI�RE4'IE�Y existing building(s). Demolition permit is required prior to issuance of building Permit for new building. M;.EXzL PtW9S;:;``,';;-"�.. LAIvTnINOPLANREVIE)� - Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD :' ❑ PU$LICl�ORICS farm if any Hazardous Materials are being used as part of this project. IRE ....... DEPT::_:.:;; ' ..; :- _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ 1u1dOR AAITA$...... ERDIS1RiCT :._:..,.___:........ _._::-fir\'1{IROIQA4ENTAti'IiEAISTII'::_ :