B-2017-0473 CITY OF CUPERTINO BUILDING PERMIT '
BUILDING ADDRESS: _ CONTRACTOR: PERMIT NO:B-2017-0473
19907 FIG TREE CT CUPERTINO,CA 95014-2314(316 30 079) GOT WOOD INC
SAN JOSE,CA 95110
OWNER'S NAME: CHEN XIAOXIN AND FANG VANIA NING TRUSTEE DATE ISSUED:09/05/2017
OWNER'S PHONE:408-806-5280 PHONE NO:(408)971-1004
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class j3 Lic.#1021532 X BLDG _ELECT _PLUMB
Contractor GOT WOOD INC Date 12/31/2018
• 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:
2ND FLOOR-REPLACE DECK; 1ST FLOOR-NEW DECK(625 SF)&
I hereby affirm under penalty of perjury one of the following two declarations: RAILING
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 ,
40 permit is issued. Sq.Ft Floor Area: 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 ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 30 079
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 again st liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against slid City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the appl Fant underst.: ds and will comply with all non-point
source regulations p r the Cupe o Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signet,1 Q. Date 09-05-2017 Issued by:Kim Dunbar
i�� Date:09/05/2017
I . ► T Myr.
DE' :,��lrJ51._:.�rr iC
I hereby aff` 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
j 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 8 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:09-05-2017
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. ['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 Ar.,.Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupert•�/o M icipa Code,Chapter 9.12 and '
exemption,'I become subject to the Worker's Compensation provisions of the the Health&Safety Code;Sect•o ns 205,27153,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall 9 T kl�,/
be deemed revoked: Owner or authorized a t. se
APPLICANT CERTIFICATION
Date:09-05-2017 Now—mow-
I certify that I have read this application and state that the above information is 1►`il ' lylYCWLE DI • Y
correct.I agree to comply with all city and county ordinances'and state laws I hereby affirm that there is a cireirction lending agency for the performance
relating to building construction,arid 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. , I understand my plans shall be used as public records. '
• Licensed
Signature Date 09-05-2017professional '
, CONSTRUCTION PERMIT APPLICATION
�' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
%r-C.I Df:
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 B.
+C4JF'>ER'••.•, . a� (408)777-3228•FAX(408)777-3333•bulldinoacupertIno.orcl B,_•71zi�- ,��yT 3
❑NEW CONSTRUCTION 0 ADDITION 'ALTERATION/TI El REVISION/DEFERRED (: ORIGINALPERM-IIT#
PROJECT ADDRESS �� ,� �y APN# ' r .. -�` ./t'i! _
OWNER NAMENsi _ PHO • IJt�� / � .gMAIL
STREET ADDRESS - ;y. CITY,STATE,ZIP ` FAX
CONTACT NAME PHO E-MAIL
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STREETADDRESSSS till
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• ❑OWNER ❑OWNER-BllIL ER' ❑ OWNER AGENT ra CONTRACTOR 0 CONIRACIORAOENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT•
CONTRACTOR NAME lxpyj- LA e)Wek•1 1itG. LICENSE NUMBER m6 LICENSE TYPE v—�• BUS.LIC# t7; 0
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STREET ADDRESS CITY$TAIE,ZIP PHONE
ARCHITECT/ENGINEER NAME 1�t . e� Y 1 LICENSE NUMBER e,' ' BUS.LIC# ,
: COMPANY NAME ;'+- T - E•[vlAa, 1 &g\R�r Lne— .CO 0 FAX
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SViSTREET ADDRESS! ' CITY,STATB,ZIP 0 PHONE• ./
• DESCRIPTION OF WORK QVI
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EXISTING USE , PROPOSED USE GONSTR.TYPE O!STfiPJE �� —�
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTO J— NEW FLOOR DEMO TOTAL '_- -- T -_ _-
AREA AREA AREA NET AREA
BATHROOM KITCHEN. OTHER
REMODEL AREA REMODEL AREA . REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH
0 ATTACH
#DWELLING UNITS: ISA SECOND UNIT []YES SECOND STORY OYES
BEING ADDED? 0 NO ADDITION? D NO
Al 4 :
PRE-APPLICATION DYES IP YES,PROVIDE COPY OF IS THE BLDG AN D YES ;RECD o;By '-.-cr' Agfi ,�j seer•TI.N:
• PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO ^'r '` -:"At' .: f
gizdA
By my signature below,I.certify to each of e folio -3g: I am the property owner-or authorized agent to act. the property owner's behalf. I have read this •
application.and the,information I'have prov ed is• rrec 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 build''-_con hvct•.n. I auth. •ze representatives of Cupertino to enter the above-i entitle,.property for inspection purposes.
Signature of ApplicantAgent!• �l IV .A Date:.rafff,MEM' G� ry
1
• SUPPLEMrNT; IN .1iON t. 'TARED _ -' .. .. �, ;_.::_L.::.:>::
=�_-��:P�nNcHEcic- sP; ::=:_-:= = =.-i � nolr>ivcskz _=rL;:-r._.
New SFD or ultifariil•dwmgs. Applyfor demolitionpermit for OLR TI� OU`NTER_-=-
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UN (-
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-
: --existin buildm s. Demolition permit is required prior to issuance of building --_ - : = = __ - _ - = - . -.,: .
.ermttfor new building Q EXPRESS~'=::=---: C7-FI: NINGTLANaREVIEcv
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CI-STA'tDARD •:; _.: .s_El''PriJSLTcwQRKS
s:i'"_-`_S:'•:r_'Z:C a`:-"moi.:>S.a { ':r-i_': a:gL•5::v.::::_:.,::�`i;•_ _F:[::<•
form if any Hazardous Materials are being used as part of this project. -- _ __--
..::LA G _: -_ ._FIRE.D
prior to - = ___ - -_ =_ - - -= = =Meeting with with Planning
Approval Letter or -- -
Co of NanningA r - - -
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submittal of Building Permit application. _:�.:::�_::::�_::::_.Y::�:::�:=�:-.::.._: :_.:.�._w.�__�.:::.... ... .> �..:-..:-
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BldgApp 20.11.doc revised•06/21/I1