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15040050 (3)CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20888 FARGO DR CONTRACTOR: SIMON ZHANG PERMIT NO: 15040050 OWNER'S NAME: LIU YOUZHONG AND ZHAO WEIYING 18488 PROSPECT RD DATE ISSUED: 06/05/2015 OWNER'S PHONE: 4084621188 SARATOGA, CA 95070 PHONE NO: (408) 887-0591 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION CONSTRUCT 2 STORY SFDWL TO INCLUDE LIVING (3942 SQ License Class L'c.# FT) ATTACHED GARAGE (439 SQ FT) PORCH (439 SQ FT) Contractorate I hereby affirm that I am licens�undee)ate aptcr (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: $600000 have and will maintain Worker's Compensation Insurance, as provided for by Stiction 3700 of the Labor Code, for the performance of the work for which this APN Number: 32630116.00 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 WORK 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 180 DAYS FROM LAST CALLED INSPECTION. 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 ,( Q Issued by: ���N � Date: 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. / RE -ROOFS: Signature Date f 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: i 1 hereby affirm that 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 1, 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 Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ageDate: nu permit is issued. 1 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 CONSTRUCTION LENDING AGENCY 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 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 1 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040050 20888 FARGO DR CUPERTINO CA 95014 (326 30 116) 18488 PROSPECT RD SARATOGA, CA 95070 OWNER'S NAME: LIU YOUZHONG AND ZHAO WEIYING DATE ISSUED: 06/05/2015 OWNER'S PHONE: PHONE NO: None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CONTRACTOR - GENERAL Lic. # Contractor Date 05/31/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that 1 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: CONSTRUCT 2 STORY SFDWL TO INCLUDE LIVING (3942 SQ I hereby affirm under penalty of perjury one of the following two declarations: FT) ATTACHED GARAGE (439 SQ FT) PORCH (439 SQ FT) 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 REV#1: LANDSCAPE REMOVE BACK YARD PRIVACY performance of the work for which this permit is issued. PROTECTION TREES I have and will maintain Worker's Compensation Insurance, as provided for by t Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $600000.00 permit is issued. 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 326 30 116 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. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS O PEWIT ISSUANCE OR source regulations perth,;upertino Municipal Code, Section 9.18. 180 DAYS FRO §F C ED I PECTION. Signature --- Date Issued by: Legacy Date: 06/05/2015 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 t. 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 of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 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 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) 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 Worker's Compensation laws of Califomia. If, after making this certificate of 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 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 agent: APPLICANT CERTIFICATION Date: �— 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 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 ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional x CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO r\�� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �v CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.oro \�U X NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # ,r PROJECT ADDRESS 4; v► Q s MR40 �O"; APN # � _,3 Q r 4 V � // OWNERNAME / (!/� O/�� J l PHONE wy- �j /Ln a„ CUP6 E-MAIL/ [.IGi �M L• STREET ADDRESS l O q � , /�Y(�GV /}�, CITY, STATE, ZIP C I / 0 / � f"O, FAX CONTACT NAME / �� PHONE�,S— - ' y K ® STREET ADDRES � Or rE-M�A'I CITY, FAX =!d O ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME , LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGI EER NAME�- LICENSE NUMBER 2 / Q BUS. LIC #/ zel i Quo a COMPANY NAME � ^ E-MAIL � � . FAX �s STREET ADDRESS/ / CITY, STA E, ZI / PHONE �O DESCRIPTION OF WORK ,r Z — S ,d J' EXISTING USE PROPOSED USE CONSTR. V-45 TYPE # STORIES 2 USE TYPE OCC. SQ.FT. VALUATION (s) EXISTG AREA NEW FLOG Aj�t3,#ISr DEMO AREA I TOTAL NET AREA 25(j q BATHROOM REMODELAREA KI HEN REMODEL AREA OTHER REMODEL AREA PORCH/ARIA DECK AREA TOTAL DECK/PO/ O 3� ETACHTTACH 1 !T i # DWELLING UMTS. IS A SECOND UNITS ❑ YES BEING ADDED' LINO SECOND S RY YES ADDITION' XO (� u TU PRE -APPLICATION YES IF YES, PR E C PY/OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTA VALUATION: PLANNING APPL # ❑ NO PLANNING O LETTER EICHLER HOME' 'KNO 1 ^ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on owner's behalf. 1 have read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to buil ng tructiondauthorize re sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: - — SUPPLEMENTAL INFORMATION REQ ED PLAN CHECK TYPE ROUTING SLIP ❑ _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER -THF -COUNTER BUILDING PLAN REVIEW permit for new building. ❑ EXPRE ING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD 'PUBLIC WORKS To—nn if any Hazardous Materials are being used as part of this project. ❑ LARGE FIRE DE _ Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR submittal of Building Permit application. S4NITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 M CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinclAcuaertino.oro Fj NRW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESSj� J� A T/ o Y APN # OWNERNAME PHONE E-MAIL STREET ADDRESS / O / CITY, TE ZIP ` FAX /�� CONTACT NAME E-MAIL STREET ADDRESSQ V6 r/ o- CITY, STATE ZI �( / J FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACT DRAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL SI'r�n lZQ-WQa ahoo. Imo-, W //1 J� FAX STREET ADDRESS ' OA i y pru � �C, V CITY, r E JZ C,�() 3,67a ,6 7 J V� / PHONE iJ ARCHITECT/ENGINEER NAME LICENSE NUMBERTI4 BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK / ' I& V EXISTING VSF PROPOSED USE CONSTR TYPE # STORIES LSI [ TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITIiON? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES REC'EIVF.DBY: TOTAL VAL ATION. PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the 1 openy H ner's behal . ha ad 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 ction. I thorize representatives of Cupertino to enter the abov identified prope for inspection purposes. Signature of Applicant/Agent: Date: Z SUPPLEMENTAL WtRTATrlt REQUIRE PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVD \N _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEVI' —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SE VER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BIdgApp_2011.doc revised 06121/11 CITY OF CUPERTINO TTT rnarvylk Ar A 11rl110 1121TTT ."INC nIV1910N NOTE: This estimate does not metuaejees aue to gine District, etc.). These fees are based on the preliminary FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) Plan Check Fee: Suppl. PC Fee: Q Reg. Q OT 0.0 hrs PME Plan Check: Permit Fee: Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs PME Unit Fee: PME Permit Fee: # new Construction Tax: IBCONSTAXR 1 units Administrative Fee: Work Without Permit? © Yes Q No Advanced Planning Fee: IPLLO,VGR Travel Documeniation Fees: Strong Motion Fee: IBSEISMICR Bldg Stds Commission Fee: IBCBSC SUBTOTALS: Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School n ormation available and are only an estimate. Contact the Dept for addn'1 in o. FEE I QTY/FEE I MISC ITEMS $3,342.57 $0.00 $0.00 $4,037.37 $0.00 $0.00 $0.00 $677.77 $0.00 $685.86 $78.00 $24.00 $8,845.57 Select a Misc Bldg/Structure - 1 or Element of a Building Select a Non -Residential -� Building or Structure Select an Administrative Item O G) O O $0.001 TOTAL FEE: I $8,845.57 Revised: 04/01/2015 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST /6040050 JOB ADDRESS: Zo $ g ,�i}-, e ti'4U PERMIT # OWNER'S NAME: p zo PHONE # GENERAL CONTRACTOR: Simom 2�a#jq Cement Finishing BUSINESS LICENSE # ADDRESS: I ¢g8 PWaeer 1Z4, it Ifl Electrical CITY/ZIPCODE: qAo a *Our municipal code requires all businesses working id the city to have a City of Cupertinolbusiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical JD YDJNfr ELEcTk(SAL co. 214? Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating z k. H M Qc� aR ca( IK(-. 34431 - Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock . IZ D R Y U/AL L INC 3000 Tile Owner / Contractor Signature