B-2016-2945Date
LIF PURPOSELL—
C T9
TACKNOWLEDGMENT
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State of California }
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ondthat
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certify under PENALTY OF PERJURY under the laws of the State of California that
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ELLEN MULBERG
@my
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z Santa Clara County
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State of California
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Kirsten Squarcia Notary PublicOnT9-
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2945
19670 DRAKE DR CUPERTINO,CA 95014-2434(316 32 024) MICHAEL LIU
94588
OWNER'S NAME: CHEN PEI-CHI AND NIU ET AL DATE ISSUED:02/07/2017
OWNER'S PHONE:408-646-3593 PHONE NO:(925)828-0869
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#1004434
Contractor MICHAEL LIU Date 06/30/2017 X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
1ST FLOOR REMODEL(1903 S.F);DEMO PLAY ROOM(160 S.F);(N)
I hereby affirm under penalty of perjury one of the following two declarations: 2ND STORY ADDITION(1399 S.F);REPLACE FURNACE AND ADD
1. I have and will maintain a certificate of consent to self-insure for Worker's (N)TANKLESS WATER HEATER;ELECTRICAL PANEL UPGRADE
Compensation,as provided for by Section 3700 of the Labor Code,for the (200 AMP).
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by DEF#1 -ROOF TRUSSES-ISSUED 6/2/2017
Section 3700 of the Labor Code,for the performance of the work for which this REV#1-FIRST FLOOR:ADD(1)WINDOW TO BEDROOM#3;
permit is issued. REVISE LAYOUT OF MASTER BATH AND RELOCATE WINDOWS
APPLICANT CERTIFICATION SECOND FLOOR:REVISE BATHROOM#1 LAYOUT;REVISE THE
I certify that I have read this application and state that the above SIZE AND LOCATION OF WINDOWS AT WET BAR.-ISSUED
information is correct.I agree to comply with all city and county ordinances 6/21/2017
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for Sq.Ft Floor Area: 1399 Valuation:$350000.00
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. APN Number: Occupancy Type:
Additionally,the applicant understands and will comply with all non-point 316 32 024 R-3(Custom)
source regulations per the Cupertino Municipal Code,Section 9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
Signature Date 6/21/2017 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: Issued by:Abby Ayende
1. I,as owner of the property,or my employees with wages as their sole Date:02/07/2017
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) RE-ROOFS:
2. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofmg material being installed.If a roof is
contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
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 Signature of Applicant:
performance of the work for which this permit is issued. Date:6/21!2017
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will
exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health&Safety Code,Sec 33,and 25534.
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 jJ
age /� y�
to enter upon the above mentioned property for inspection purposes. (We)agree Owner or authorized _
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:6/21/2017
judgments,costs,and expenses which may accrue against said City in ' •NSTRUCTION LENDING AGENCY
consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.)
Code,Section 9.18. Lender's Name
Lender's Address
Signature Date 6/21/2017
ARCHITECT'S D . . .A ATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2945
19670 DRAKE DR CUPERTINO, CA 95014-2434 (316 32 024) MICHAEL LIU
PLEASANTON,CA
94588
OWNER'S NAME:
OWNER'S PHONE:
License Class JR Lic. #1004434
Contractor MICHAEL LIU Date 06/30/2017
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:
t. 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.
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
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 6/2/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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 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
I certify that I have read this application and state that the above information is
correct. 1 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 6/2/2017
DATE ISSUED: 02/07/2017
PHONE NO: (925) 828-0869
BUILDING PERMIT INFO:
BLDG X ELECT X PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
1 ST FLOOR REMODEL (1903 S.F); DEMO PLAY ROOM (160 S.F); (I)
2ND STORY ADDITION (1399 S.F); REPLACE FURNACE AND ADD
(N) TANKLESS WATER HEATER; ELECTRICAL PANEL UPGRADE
(200 AMP).
DEF #1 - ROOF TRUSSES - ISSUED 6/2/2017
REV #1 - FIRST FLOOR: ADD (1) WINDOW TO BEDROOM #3;
REVISE LAYOUT OF MASTER BATH AND RELOCATE WINDOWS I
SECOND FLOOR: REVISE BATHROOM #1 LAYOUT; REVISE THE
SIZE AND LOCATION OF WINDOWS AT WET BAR.
Sq. Ft Floor Area: 1399 1 Valuation: $350000.00
APN Number: Occupancy Type:
316 32 024 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 Aygnde
Date: 02/07/2017
RE -ROOFS:
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.
Signature of Al
Date: 6/2/2017
TO BE CLASS "A" OR BETTER
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 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.
Owner or authorized agent «
Date: 6/2/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction 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.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NOS
B-2016-2945
19670 DRAKE DR CUPERTINO, CA 95014-2434 (316 32 024)
MICHAEL LIU
PLEASANTON,CA
94588
OWNER'S NAME:
DATE ISSUED:
02/07/2017
OWNER'S PHONE:
PHONE NO: (9I5)
828-0869
LICENSED CONIRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #1004434
Contractor MICHAEL LIU Date 06/30/2017
X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X
— MECH X RESIDENTIAL — COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
1ST FLOOR REMODEL (1903 S.F);
DEMO PLAY ROOM (160 S.F); (N)
I hereby affirm under penalty of perjury one of the following two declarations:
2ND STORYADDITION (1399 S.F),
REPLACE FURNACE AND ADD
1. I have and will maintain a certificate of consent to self -insure for Worker's
(N) TANKLESS WATER HEATER;
ELECTRICAL PANEL UPGRADE
Compensation, as provided for by Section 3700 of the Labor Code, for the
(200 AMP).
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: 1399
Valuation: $3$0000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is
APN Number:
Occupancy Type:
correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
316 32 024
R-3 (Custom)
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 this permit.
Additionally, the applicant understands and will comply with all ll non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
21712017
Issued by: Abby Ayende
e//
OWNER -B TILL R DECLARATION
Date: 02/07/2017
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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 01
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO, BE CLASS "A" OR BETTER
1. lb ave 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
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
material. Additionally, should I use eggrpment or devices which emit hazardous
air contaminants as defined by the Bay Irea 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.
Owner or authorized gq nt:
APPLICANT CERTIFICATION
Date: 2/7/2017 G y
I certify that I 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 issue (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
ARCHITECT'
1 understand my plans shall be used as public records.
Code, Section 9.18.
Signature Date 2/7/2017
Licensed
professional