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B-2016-1700CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1700 10553 LARODADR CUPERTINO, CA 95014-4430 (369 33 024) RE-CREATION CONSTRUCTION INC SAN JOSE, CA 95129 OWNER'S NAME: WANG STANLEY AND YANG YA-LING DATE ISSUED: 09/07/2016 OWNER'S PHONE: f I PHONE NO: (650) 868-8245 IN 011 _,.-i 411XV-6XII 1111MAXIM011143411-61 MU -11M License Class _QENERAL BUILDING CONTRACTOR Lic. #945926 Contractor RE-CREATION ON TRU TION INCDate 04/30/2018 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: i. 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. 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. 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. Date 11722/2016 OWNER -B iii D R D . LA ATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. 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: I. 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. 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 Icertify 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 taws 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 11 /2 212 01 6 BUILDING PERMIT INFO: X BLDG —ELECT — PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (1) TWO STORY RESIDENCE (2958 SQ FT); ATTACHED GARAGE (415 SQ FT); FRONT PORCH (43 SQ FT); REAR PATIO (293 SQ FT) SECOND STORY BALCONIES (105 SQ FT). REV #1- CHANGE MASTER BATHROOM LAYOUT ISSUED 11/22/2016 Sq. Ft Floor Area: 3373 l Valuation: APN Number: Occupancy Type: 36933024 Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),Deferred Submittal (R- 3),Deferred Submittal (R-3),Deferred Submittal (R- 3),Deferred Submittal (R-3),Deferred Submittal (R- 3),Deferred Submittal (R-3),Deferred Submittal (R 3),Deferred Submittal (R -3),U (Private Gar /Ag Bldg) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar 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 ofApplicant: Date: 11/22/2016 "A" OR BETTER 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: 11/22/2016_ ON TR TION 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 I understand my plans shall be used as public records, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS CONTRACTOR: PERMIT NO: B-2016-1700 10553 LA RODA DR CUPERTINO, CA 95014-4430 (369 33 024) RE-CREATION CONSTRUCTION INC SAN JOSE, CA 95129 OWNER'S NAME: WANG STANLEY AND YANG YA-LING OWNER'S PRONE: LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #945926 Contractor RE-CREATION CONSTRUCTION INC Date 04/30/2018 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: 2. I have and will maintain a certificate of consent to self -insure for Worker's DATE ISSUED: 09/07/2016 PHONE NO: (650) 868-8245 PERMIT INFO: BLDG —ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (1) TWO STORY RESIDENCE (2958 SQ FT); ATTACHED GARAGE (415 SQ FT); FRONT PORCH (43 SQ FT); REAR PATIO (293 SQ FT); SECOND STORY BALCONIES (105 SQ FT). Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. i2 m 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: 3373 1 Valuation: $450000.00 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 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. i' Signature Date 09/7/2016 APN Number: Occupancy Type: 369 33 024 R-3 (Custom),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: Kim Dunbar Date: 09/07/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF. -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 inspection. compensation, will do the work, and the structure is not intended or offered f sale (Sec.7044, Business & Professions Code) 2. 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. 1 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 or 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. 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 09/7/2016 Signature of Applicant: Date:09/7/2016 TO BE CLASS "A" . 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. 1 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: 09/7/2016 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 understand my plans shall be used as public records.