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B-2017-1271CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1271 10090 PASADENAAVE STE A2 CUPERTINO, CA 95014-5939 (357 17 084)110090 PATRICK JEAN -PHILIP PASADENAAVE STE Al CUPERTINO, CA 95014-5939 (357 17 083) BURGER HAYWARD, CA 94544 OWNER'S NAME: WU WEI AND SUN YI DATE ISSUED: 08/09/2017 OWNER'S PHONE: 408-930-3016 PHONE NO: (415) 595-5457 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #Z53169 Contractor PATRICK JEAN -PHILIP BURGER Date 05/31/2019 YX BLDG _ELECT _ PLUMB 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: REPLACE (E) DECK UNIT Al (370 S.F.) LIKE FOR LIKE; REPLACE I hereby affirm under penalty of perjury one of the following two declarations: (E) DECK UNIT A2 (399 S.F.) LIKE FOR LIKE 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. 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 Sq. Ft Floor Area: Valuation: $18500.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 357 17 083 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 Cupert'no Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signa Date 08/09/2017' Issued by: Kim Dunbar Date: 08/09/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: I 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.7944, Business & Professions Code) 2. I, as owner ofthe property,.am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 08/09/2017 I hereby affirm undepenalty of perjury one of the following three declarations: I „r ALL ROOF COVERINGS TO BE CLASS A„ OR BETTER r. 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 performance Code, for the perfoance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will I is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit s. 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 1, I I _ 1 shall not employ anyperson 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 California. If,`after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I 9.12 I'become'subject to the Worker's Compensation of will maintain compliance with the Cupertino Municipal Code, Chapter and Health & Safety Code, Sections 25 05 533 25534. exemption provisions the Labor Code, �I must forthwith comply with such provisions or this permit shall the and be deemedrevoked., Owner or authorized agent APPLICANT CERTIFICATION Date: 08/09/2017 I certify that I have read this application and state that the above information is COAC L INGAGENCY correct. I agree to comply wlth;all city and county ordinances and state laws I hereby affirm that there is a cc struglKh lending agency for the performance relating to building constructlonl, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the a8&e mentioned;property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harml'e'ss the City of Cupertino against liabilities, judgments, cost's, and expenses which may accrue against said City in Lender's Address consequence ofl the granting oflthi'sl permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18.E 1 understand my plans shall be used as public records. Licensed Signature Date 08/09/2017 professional ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION1M In COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building .cuaertino.org ❑ ADDITION EM/ALTERATION/Tl ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS f+,� F!<j•' j/t OWNER NAME ` PHONE 2JD E -MJ 1 �r7fr j G6 �5_ ,o l , cle STREET ADDRESS Crl'Y,• STATE, ZIP FAX CONTACT N !' I✓ "_ P ONEQ i/ �7 � '�iVi 'vlc�0� "i tG�W1� iJc_ . STREET ADDRESS CrrY, STATE, ZIP FAX f. J©e� c . �r ❑ OWNER ❑ OWNER -BUILDER OWNER AGENT CONTRACTOR J�rCONTRACTORAGFNT ❑ ARCHITECT ❑ ENGNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSENUMB C LTCBNSETYP • BUS, LIC TI (Jx '9 ny C iPANV NAME tl+$iislt' • r%/� � E M...p/ �ILFAX 11^ t ctrCS c. P %A, Gf G STREET, ADDRESS CrAr STA E, ZIP FHONE ) CHITFCI'JENGIN ER NAME LICENSENUMBER HU ,Lift C� P,ANYNAIvIL• Pft'/G P E-, IL ! i' FAX r %�.brt�lJ rlG2 �� a �� �• .� STREIITADDRESS q PITY, STATE, ZIP �+ a PHONE is') (`eu1R ` 11 . ltDCSCitll'TIONOF WORK ;` . �� ! :. I, J r ra c -d a ,u Po /L-jtJ CiEs w C-1 O I x J' �� &'4 0A A AA 1 Ls f .f AD �J 41- N C,� V T*-�� R� b 0' C-. 4�QI-Akr rn " n, c� � �L p �a✓r r ,. c�� EXISTING USE . I l PROPOSED USE !'il i i CONSTR. TYPE N STORIES '!' ///000 USE TYPE OCC, SQ,FT, VALUATION{$) EXIST "Iwg AR£AI!v / •I NEW FLOOR AREA y ! DEMO AREA'A TOTAL .NET AREA ut I' BA•I'HR00 I: Kn Ii1:IV! RL-n90DEL ARER , ` y RE -MODEL ARE/8 i OTtiF1t REMODEL AREA jJ !, ' I,PORCHAREA; l; £CK AREA , TOTALDEC RCHAREA/ GARAGE REA: DETACH 0--s A ❑ ATTACH 'AD G S: 1S A SECONDUNIT ❑YES BEING ADDED? �-wo 1 ',, SRCOND TORY ❑YES ADDITION? NO , ! :I I; PRE -APPLICATION '❑AYES . IF YES, PROVIDE COPY OPT PLANNINOAPPI:� 0 .j PLANNINOAPPItOVALLE'IT£R ISTIIE BLDG AN ❑ YES F•iC1tLERIIOME? 0 _ - - _ ABY-_= - -= = •'�':. i.- —_---'''`���'-_"'`'�- =-= ;�==G-�'- T TAL VALUATION: By my signature beluw, I certify 'to each' of the following; I am the property owner or aut iorizffao to act on the property owners behalf. I hate read this I application and lhe'information I have p*'lded is correct. I have read the Description of Work and verify it is accurate. I agree to comply with'all applicable local O�dmanoes and state laws relatingto b o struction. I author i representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of /A --�-- Date: ' I .;REQUIRED' l. „ SUPPLEMENTAL INFO1tMAT N it)rQUIItED • — • New Sl'I) or Multifamily. dwI lings. Apply for demolition permit for �-eta;-:.:;-.,:,._x:_r•.:.,_;-_..:.__.... - - -- = — ~ --- :I-I:_O\!� �THE.Cli71ILIt' -u` ._.. ._. .:. ,_... r...� - YI;YJIIA.I1iGPLtL�TIiEYIEVS'.. ?-= existfn bwldin s . Demolition: erntit is required prior to issuance of buildin .I ermi fornewb'ildin t u P g?.::,,... _ __ - --- - - _ — --- - -- -_ - -- - - - - 1 I elcompleted- I. Co cal Bid s.. Provide a Hazardous Materials Disclosure :gym..:-...:.� .•-;�-.v.<,�_=.....,�:� :'.w.;..:. '.d_�:m'�""'•�t1b-�-:^_�-�-A= � �1I' a -.:.;-.r=, �_ - �.?(]`:'�1�tiBxC_t�VOltr�-c-=__-_:c.---'::.:_,.::` t formlif an azardous Materials are being used as art ois project. yH f h --- - -_ - - -- - _ I Copy ofP.. ' lannmgApproval Letter or MePlanningng with Planning priorto =�-r•~'=, �--"" - °---� � ___ _ _ submittal ofBuilding Perm t application, :EIV'I±IROnl14ENTlLYiEAL7I��=°:-__:;t BldgApp__2011.doc revised 06/21/11 M 00 I