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B-2017-0030CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0030 10125 BANDLEY DR CUPERTINO, CA 95014-2101 (326 34 047) S O S CO PAVING & GRADING TRACY, CA 95376 OWNER'S NAME: LEONG SAI HOU TRUSTEE DATE ISSUED: 03/03/2017 OWNER'S PHONE: 408-838-9328 PHONE NO: (510) 677-9806 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Q-12 Lic. #1004815 Contractor S O S CO PAVING & GRADING Date 06/30/2017 X BLDG —ELECT —PLUMB MECH RESIDENTIAL X 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: ACCESSIBILITY - RE -STRIPING SPACES (7), ADDING (N) RAMP I hereby affirm under penalty of perjury one of the following two declarations: REV# 104-24-2017 -AC PAVING ADDITION (1200 SF); SLURRY SEAL 1. I have and will maintain a certificate of consent to self -insure for Worker's (4200 SF) ISSUED 5/5/2017 Compensation, as provided for by Section 3700 of the Labor Code, for the rfonnance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance, as provided for by Iec tion 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $15000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 326 34 047 326 A (Tenant Improvements) 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 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 regulatipns per_th Cupertino u ' 'pal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signattire- // Date 05/05/2017 Issued by: KIM DUNBAR OWNER DECLARATION Date: 03/03/2017 -BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RF -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. 1, 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: 05/05/2017 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. 1 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 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 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 & SafetySections2550 2553 , an 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authoriz en APPLICANT CERTIFICATION Date: 05/05/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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 I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 95/05/2017 Professional CONSTRUCTION PERMIT APPLICATION. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVU V ISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • bull ding @cupertlno.Org } ❑ NEW CONSTRUCTION ❑ ADDITION TERATION / TI ❑ REVISION! DEFERRRREED ORIGINAL PERMIT # PROJECT ADA SS �.�� ! r' �! APN # , 3� v (ilk% � OWNER N M P '0 E-MAIL STREETADDRES,�, CITY, TA E, zip /1 FAX CONTACT E PIi NE 11 -MAIL ( STREE el DRESS CITY, STATE, ZIP FAX___— ❑ OWNER ❑ OWNER -BUILDER L3 OWNER AGENT ❑ CONTRACTOR 13CONTRACTOR AGENT CHITHCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONT CTORNAMEM LICENSE �R, (t LICENSETYPE B COMPANY NAME STREET ADDRESS CITY, STATE, ZIP PHONE'Lk 2 , , P ) :1, � i Ca ARCH7G E LICENSE N M P. BUS. LIC 9 COMPANY NAME �� t� ✓JCS CC) �CJ E-MAIL sys7c-ncS FAX sc�s�� I) v'h rC .;0 STREET ADDRESS b ` / ^ C.^ C` / C L. /4/ } T CITY, STATE, ZIP ^ r _ l— PHONE / t DESCRIPTION OF WORK /J U --6q �� 3-D 1�b b A& VMft'E'M rV�G q J tJV v) ioo iugl) /7kt --fi -�tpr EXIST .G US� I PROPOr` SE COUR. TYP # STORA -s USE TYPE OCC. SQ.FT. VALUATION ($) FXISAG NEW ILOOk DEMOT ARRA 92 1 AREA AREA 1�1ET AREA BATHROOM REMODEL AREA N IODEL AREA OTHER __'! REMODEL AREA(I PORCHAREA DECK TOTALD K/P RCH AREA GARA AREAI LIDETACH I ❑ ATTACH #DWEL,24 S: IS A SECONDUNIT ES SEC NDSTORY AYES BEING ADDED? ADDITION? ❑NO FRE -APPLICATION El YES Ir YES, PROVIDE COPY OF PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YL•5 EICHLERHOME? [-]NO Y: AV 'TOTAL VA LUATION: By my signature below, I certify to each of the following: I am the property owner or autborize agent to act oB the property owner's behalf. I have read this application and the information I have provided is comet. 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 t b ing construction, I authorize representatives of Cupertino to enter the above -id entifiel property f r inspection purposes. Signature of Applicant/Age Date: r �/ SUPPLEMENTA I FO N REQUIRED PLAN CHECK TIT E _ ROUTING sLlr _ New SFD or Multifamily dW IlingS: Apply for demolition permit for ElOVER-THE-COUNTER �i�,A �BUILDINC PLAN REVIEtY! f" " existing building(s). Demolition permit is required prior to issuance of building for 401 permit new building. ❑ EXPRESS V/PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 4/PUBLIC WORKS kA.) 11214 form if any Idazardous Materials are being used as part of this project. ❑ I.ARGF ❑ I,E Dy 'PT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑-AIAJOR ElSANITARY srwFR DISTRICT submittal of Building Permit application. El ENwiRONnIENfALHEALTH B1dgApp_2011.doc revised 06121/11 �w T CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0030 10125 BANDLEY DR CUPERTINO, CA 95014-2101 (326 34 047) S O S CO PAVING & GRADING TRACY, CA 95376 OWNER'S NAME: LEONG SAI HOU TRUSTEE DATE ISSUED: 03/03/2017 OWNER'S PHONES 408-838-9323 PHONE NO: (510) 677-9806 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class EARTHWORKAND PAVING Lic. #1004815 Contractor S O S CO PAVING & GRADING Date 06/30/2017 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 fuhl,fo cc and effect. JOB DESCRIPTION: ACCESSIBILITY - RE -STRIPING SPACES (7), ADDING (1) RAMP I hereb of r der penalty of perjury one of the following two declarations: j' and will maintain a certificate of consent to self -insure for Worker's o—m sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. z. 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: $15000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 34 047 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 CupertinoMunicipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 03/03/2017 Issued by: PAUL O'SULLIVAN OWNER -BUILDER DECLARATION Date: 03/03/2017 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 r. 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: 03/03/2017 I hereby affirm under penalty of perjury one of the following three declarations: AL • 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 z. 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 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, 25533yand 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized !- APPLICANT CERTIFICATION Date: 03/03/2017 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 CONSTRUCTION LENDING AGENCY 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 ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 03/03/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPlrRiiPiO (408)777-3228-FAX(4Q8)777-3333-it1111(IIIIC ,GUp8T11t10.OTC[ rr_�� El NEW CONSTR(JCTION L_ i—� 1 ADDITION TERnATION I TI lj REVISION I DEFERRED ORIGINAL PERMIT # PROJECT � y a�^y y/�..�....,-- ` APN !{ OWNERNAME1 4 I t I.'S- CITY, ATE ❑ OWNER CI OWNER -BUILDER C1 OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AG ENT CONTRACTORNAME__1,—�� L ESE h ER f � r �— COMPANY NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP ARCHTIECTIENGINE LICENSENUMBER COMPANYNAML' ••�—•-..�..— ._.—.. _..._—....--� E-MAIL STREET ADDRESS _� CITY, STATE, ZIP s f��_. DESCRIPTION' OF WIC -OHAets SED F�., 1%P,f3SE S td �. R_TYPE �� T07 USI: .P—..— TOTAL iE70STG NEW FLOOR DEMO NET AREA AREA AREA AREA BATHROOM KITCHE OTHER REMODEL AREA REMODEL AREA REhIODEL AREA PORCH AW DECK AR9A TOTAL. DECK 0RCII AREA GARAG,6 AREA; rIATTA H FAX FAX I ARCHITECT- ❑ ENG1NEER ❑ DEVELOPER ❑ TENANT LICF,NSETYPE IIUS. LIC # FAX PHONE EUS.I.TC# FAX PHONE T_ A TYPE I =.)CC. I StZyT, f VALUATION (S) 1DWE1 LllJ�UNITS: j IS A SECOND OR,[ I' u ca BUNG ADDED'! 1 O au�un il ..,,.. u --� AODr OR? off) PRE -APPLICATION ❑YES -IF YES, PROVIDE COPY OF IS THE BLDG UYE fRE.':_._.E_DATION• PLANNING APPL A j] NO P LANNn.GAPPROVALLETTL•R ' EICHLERHOME. ❑ y Vowner's the following: 111111 tite property owner or authorize agent to act on the property behalf. I have_ read this By my signature below, I certify to each of 'ovided I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local � application and the 1nfonuatior I have I is correct. Cupertino to enter the above -identified pro a €or inspection pwposes. ordinances and state laws relatittg to bu dill' can. unction. I aufhorize representatives of y s�s~d Signature of Applicant/Agent: Date: SUPPLFMENTAI, FO A REQUIRED - - - -_ a;ir�_:=,,,7:_ °;-.:==:PiancxEcxx�'e.E=< ';--Ifi'INGSliIP_._'-`_sci=•sL - -- __ New SFD or Multifamily dwell ngs: Apply for der11411t1Ori permit f0I .cO%�;ot'>I=Ti�co[>rri:,R �=�_= _..,_::�, } , •.::.rc.._ •:::: ,..-:==-; r=����-~ ''. -xtstangbutld' Demolition pe required issuance of building : --- -- _:;-_,-:.� -�. .a(s). ernlit for new building. -0 '�a]'EYPRESS�<v`-'���;i'f��=:`r:;--:=_<-'=•::L:::�._�=.:.._:;5;,::-,�,.-::�t`h. p]�AnnIIvGFI:I�iRCVIE}1'�-`= Hazardous Materials I71sCIOSUTB _ IC II0-.TSTA\'QAR➢'':?..�a�:=`: ...._. ,._:�- -- __- _=:- �`•': . -. �:-.�.==:::._>:-c<::=_�;=:r _°'::,=:--_�::`::•: CCommercialrcial Bldgs: Provide a completed ,x.•� _ form if any Hazardous Materials are being used as part of thus project, ❑.- LARGE > Copy of Planning Approval Letter or Meeting with Planning prior to _ T�;.'�3OR C] SARITAR] SE1i ERAISTRICT submittal of Building Perinit application. _ - - O`. Eiir lzciiaiilENTAL>i�ALTK - � B1dgApp 20ll.doc revised 06/21/11