B-2016-2740CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2740
19907 FIG TREE CT CUPERTINO, C
950114-2314(31630079)
CREATIVE EXTERIOR
BUILDERS INC
SACRAMENTO, CA
95826
OWNER'S NAME: CHEN XIAOXINAND
FANG VANIANING TRUSTEE
I
DATE ISSUED: 09/15/2016
OWNER'S PHONE: 408-806-5280
I
PHONE NO: (916) 739-0611
I IC_.ENSr.] [ON .
BUILDING PERMIT INFO:
License Class E Lic. #909585
Contractor CREATIVE EXTERIOR BUILDERS INC Date 01/31/2018
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed u (der the of Chapter 9 (commencing
y
_ MECH X RESIDENTIAL _ COMMERCIAL
provisions
with Section 7000) of Division 3 of th Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
I hereby the following two declarations:
REPLACE EXISTING SIDING WITH JAMES HARDIE FIBER CEMENT
affirm under penalty of perjury one of
SIDING (3000 SF)
1. I have and will maintain a 4rtificcate 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 fob` which this permit is issued.
t t - 2 I have and will maintain Worker's Compensation Insurance, as provided for by
Y ° Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $30000.00
APPLICANT CER'T'IFICATION
I certify that I have read this applic lion and state that the above
information is correct. I agree to cor ply with all city and county ordinances
�N Number:
Occupancy Type:
and state laws relating to building cpnstruction, and hereby authorize
316 30 079
representatives of this city to enter Opon!the above mentioned property for
e) ag to save indemnify and keep harmless the
inspection pgaconsequence
City of Cupliab' i es, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrueCi 'consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,t erstands and will comply with all non-pointsource
reguupertinp Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
I
'
Signature Date 9-15-2016
Issued by: Kim Dunbar
OWNER-BUILDER DECLARATIQN
bate: 09/15/2016
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
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.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (See.7044, Business & Professions Code).
Date: 9-15-2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL 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' by Section 3700 of the Labor Code, for the
performance of the work fof 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, d 25534. I will
maintain compliance with the Cupertino Municipal Code, apter 9.12 and the
permit is issued.
s. I certify that in the,performance oHealth
f the work for which this parrot is issued, I
& Safety Code, Section 25532(a) should I store handle hazardous
material. Additionally, should I use eq pme ` or devic which emit hazardous
shall not employ any persoh in any manner so as to become subject to the
air contaminants as defined by the B Area ' Quali Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the C ertin Munici Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health &Safety Code Secti s 2550 5533, 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: 9-15-2016
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
ON TRU TION LENDING AGENCY
firm that there is a construction lending agency for the performance
I hereby affirm
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,
Lender's Address
judgments, costs, and expenses }rich may accrue against said City in
consequence of the gr ting of hia permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with non-p nt source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section .18.
Licensed
Signature Date 9-15-2016
Professional
C NSTRUCTION PERMIT APPLICATION
C MMUNITY DEVELOPM ENT,DEPARTM ENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(468) 777-3228 • FAX (408) 777-3333 • buiIdingCaD_CUperbno.org
CUPERTINQ j�e7AEl
0,r/ GV
NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
i
PROJECT ADDRESS G} Q ��f I y -Yep- APN
ORWNER NAME
STREET ADDRESS
CONTACT NAME
V�
STREETADDRESS
13 OA'NER ❑ OWNER-B=ER ❑ �
CONTRACTOR NAME
COMPANY NAME
STREET ADDRESS- kI ^A.n
A RCHITECTIENGINEER NAME
COMPANY NAME
i
STREET ADDRESS
DESCRIPTION OF
EXISTo NEW FLOOR
AREA AREA
BATHROOM- KIT(
REMODEL AREA REDS
PORCH AREA I DECK AREA
A n *n PHONE �.yC E�M
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CITY, STATE, ZIPw Q� IGG�(
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CITY, STATE, tZIP FF
ER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECTS ❑ ENGLNEER ❑ DEVELOPER ❑ TENANT
LICENSE NUMBERQ On�135 7
LICENSE TYPE s BUS. LIC n 2 5r
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ZIP STATE, , PHONE
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LIICCENNSSE NTUMBER I BUS. LIC 9
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CITY, STATE, ZIP
—� CONSTR. TYPE # STORIES
Q USE
DEMO TOTAL
AREA NET AREA
OTHER -
REMODEL AREA
ATTACH
FAX
PHONE
install new? 5��211ncj �yl
TYPE OCC. SQ.FT. VALUATION (S)
DWELLING UN11TS:
IS A SECOND UNIT LJ YES
BEING DED? [:]No
SECOND STORY L l YtS
ADDITION? [-]NO
PRE -APPLICATION ❑YES IF YES,. PROVIDE COPT OF
IS AE BLDG AN ❑YES
REC£IV£D BX
g
TOTAL VALUATION:
PLAI.NLYG ADPL n. [:]NO PLAN?N KG APPROVAL LETTER
LER HOME? El NO
'�
a
By my signature below, I certify to'each' f th followin
am the property owner or authorized agent to act ontheproperty owner's behalf. I have read this
application and the information I have , vi d is co
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 ild' ons
i mhorize representatives of Cupertino to enter the abgove dentifi dyypropelty for inspection purposes.
Signature of
Date: ` ts�l�
SUPPLEMENTAL INIFORMATION REQUIRED
New SFD or Multifamily dlwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
—Commercial Bldgs: Provk e a completed Hazardous Materials Disclosure
fonn if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
CHECKSIPE x t' „, ROIITING SLIP
Ot £R THE COUISTER ❑BUILDING PLAN REl iER
EXPRESS ❑*PLAiiNINGPLANREDIEti�' \
STA �DARD PUBLIC 1� ORKS
L9RGE �� � FIRE DEPT ti
?�ZAIOR � � ❑�S�ivrLAR� SEAi'ERDISTRICT`
I]...:ENYIROTS7VIE;STA FIEALTHi"`; :Ml
BldgApp_2011.doC revised 06121111