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B-2016-1386 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:'B-2016-1386 22466 RANCHO VENTURA ST APT B CUPERTINO,CA(357 03 012) (CABINET&STONE EXPO INC) SAN JOSE,CA 95131 OWNER'S NAME: KUEI TSAO-LINTRUSTEE DATE ISSUED:03/01/2016 OWNER'S PHONE:408-313-1338 PHONE NO:510-589-2018 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie.#980995 Contractor(CABINET&STONE EXPO INC)Date 03/01/16 X BLDG —ELECT —PLUMB T hereby affirm that I am licensed under the provisions of Chapter 9(commencing 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: CONSTRUCT ONE STORY MASTER BEDROOM ADDITION(189 SQ I hereby affirm under penalty of perjury one of the following two declarations: FT);INTERIOR REMODEL OF BATHROOM AND CLOSET(55 SQ FT). 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. Sq.Ft Floor Area:378 Valuation:$20000.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction,and hereby 357 03 012 R-3(Custom) 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Addition the applicant understands and will comply with all non-point sour regulatio per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code,Section 9.18. Issued by:Sean Hatch Sign e Date 03/01/16 Date-'03/01/16 OWNER-BU"ER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: z. I,as owner of the property,am exclusively contracting with licensed Date:03/01/16 contractors to construct the project(Sec.7044,Business&Professions Code).. I hereby affirmunderpenalty 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. 1 have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the this 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 material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air ualityManagement District I will maintain compliance with the Cupertino nicipal C e,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Se 'ens- , , 4. 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.Owner or author' agent: n be deemed revoked. Pate: 1 APPLICANT CERTIFICATION N TR N LENDING A EN Y I certify that I have read this application and state that the above information is I h y affirm that there i construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this 'y Lender's Name to enter upon the above mentioned property for inspection purposes. (We gree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION I understand my plans shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 03/01/16 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333=building c@cupertino.orcl Q NEW CONSTRUCTION CfADDITION ❑ALTERATION!TI ❑ REVISION/DEFERRED ORIGINAL PfiRMIT�## PROJECT ADDRESS ` 2 2 46G MPJWO vize�Co j2{3APN#- o,-r, 3 97 — 0 3—0 t2 OWNER NAME eT 5A0 - Lt p\J jU F—t "1409.)3 1 E MAIR � L <U I75�GC STREET ADDRESS CITY,STATE,ZI? FAX 10574 S, - dZ.,A- &VV z CONTACT NAME r-n4 n rv � PHONE fl E-MAILS ]� � l!= A �0� STREET ADDRESS t`y - 810 9A+4 tY� At E CITY,STATE, ZIP CA- i e�U t U lFF1�7Y ❑OWNER ®OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT pi ARCHrLECT Ci ENGINEER ❑. DEVELOPER C'TENANr CONTRACTORNAME [ LICENSE NUMBER t.ICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME n�y„J/ LICENSE NUMBER zrgCa BUS.LIC# COMPANY NAME B-YJAIL i + FAX STREET ADDRESS J2 tf. � �AJJ �. �t� AV'- CITY,STATE,ZIPT// � b e ¢ PHONE DESCRIPTION OF WORK A T F I .�„ ) �F ;9 ,,*F M TE� V - e. coo iy-- {•�.. .p /� &7 NV 3j"I c� C'Gum {� I EXISTING USE PROPOSED USE CONSTR.TYPfi {�„� *'4 #3TOR1E5 - - DUGV� D0{ Sy�� .'46 6 USE TYPE OCC. SQ.FT. VALUATION{$) EXISTG NEW FLOOR V Y DEMO TOTAL ! y� ARBAINB55 AREA #.$ AREA NET AREA 3() BATHROOM KITCHEN OTHER REMODEL.AREA sN REMODEL.ARBA REMODEL ARRA PORCH AREA DECKAREA TOTALDECKIPORCHAREA GARAGE AREA: U DETACH El ATTACH DWELLING UNITS: ISASECONDUNIT []VES ' CONDSTORY [LYES .� BEING ADDED? 'p-NO ADDITION? ©,NO PRE-APPLICATION NrYES IF YES,PROVIDE COPY OF IS THE BLDG AN C1 YES TOTAL VALUATION: PLANNING APPL# QNO PLANNING APPROVAL LETTER EICHLEREOME? [RNO a�V By my signature below,I certify to each of the following: I am 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 correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building_wnstruction. I authorize representatives of Cupertino to enter the above-identified pt,�ferty for inspection purposes. Signature of Applicant/Agent: Dater l( SUPPLEMENTAL INFORMATION REQUIRED Q - PLANCHEMTYPE.. 20[}TINGSLIP New 5FD or Multifamily dwellings: Apply for demolition permit for :El-'OVER'TBFrCoi fPER 1 xUILIIPIG:FLAN Iu vlEw existing building(s). Demolition permit is required prior to issuance of building permit for new building RxrREss y� ELANNI�1G PLAN xEuly `UP .,.. . _Commercial Bldgs: Provide a.completed Hazardous Materials DisclosureSL sTnii'1D!kM V � C1 PUBLic WORKS farm if any Hazardous Materials are being used as part of this project. Lr Jfij v LARGE= Q :)IRE.DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. t] ��aAsoR sANITARY st wr R urs rRICT .ENVIR.ON3YIE.NTAI..:HEALTMf - Bldg4pp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 9501.4-3255 Telephone:408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR 1 SUBCONTRACTOR LIST JOB ADDRESS: 2� So i4. PERMIT OWNER'S NAME: uE PHONE# GENERAL CONTRACTOR: ero _ ,,..c. BUSINESS LICENSE# ADDRESS:: ( 1 5 ��. CITY/ZIPCODE: as1 *Our municipal code requires all businesses working in the city to have City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY NSPEC ION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB OBTAINED A!CITY OF CIJPERTINO BUSINESS LICENSE. I am not using any subcontr ors: Signature Date Please check app ° able subcontractors and complete the following information: SUBC NTRACI'OR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical Excavation 1 Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Pleating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing _ Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date INSPECTIONS, I CONSTRUCTION INSPECTION SPECIALISTS L DSAFILE# 690 SUNOL ST., BLDG. H " SAN JOSE, C 95126 DSAAppl. # (408) 288-8460 - FAx: (408) 271- 902 OSHPD# ANCHOR INSTALLA N I CTION REPORT City of: Y 10.4'9 7-W 0 —Date:—*3 - 3-10-716 Project Name: Project#— C 0 0 1 2 / q Addreclo. 6 G A?-AAl #o Vlz-X)7-a A /4 t-90)(a— lag , Permit# Inspectors Name: t ID#___l 0 7 7 2 1,6 - --------------------------------------- Installation Inspection of:M�poxied Reinforcing Steel Dowels 71 Epoxied AlIthread Anchors 0 Expansion Anchors MWitnessed the drilling of the holes and verified proper diameter and depth. (or) 0frispected predrilled holes and verified proper diameter and depth. 'Observed the cleaning of the holes and th injectiosertionof rll�1140Y 17 poxy capsules/grout, ICCER# Expiration Date ,nWitnessed the proper insertion of: (No.) diameter allthread anchors /(re:i:nf®rin steel dowels, expansion ancho'r's inches in length, embedded inches, at the following location: (No.). diameter allthread anchors /erelf-n wels�/ expansion anchors �forcin steel inches in length, embedded inches, at the following location: (No.) diameter allthread anchors /(r:ei:nf:or:c�insteel eel / expansion anchors 40 inches in length, embedded inches, at the following location: -------------------------------------- Notes: To the best of my knowledge, work inspected was in accordance with the building department approved design drawings, specifications and applicable workmanship provisions of the C.B.C. ex-Gapt-a's-rittred-above: Inspectors' signature: