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B-2017-0540CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23687 BLACK OAK WAY CUPERTINO, CA 95014-6557 (342 56 023) OWNER'S NAME: MARAQAAMMAR FUAD AND SONG ANGELA YUUN TRU OWNER'S PHONE: 408-483-5837 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #927584 Contractor PANORAMA CONSTRUCTION Date 01/31/2019 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: 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 �pefformance 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. 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 Cuperfpp Muni�''pal Code, Section 9.18. Date 4/4/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 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. 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. 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. 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 4/4/2017 CONTRACTOR: PERMIT NO: B-2017-0540 PANORAMA CONSTRUCTION CAMPBELL, CA 95008 DATE ISSUED: 04/04/2017 NO: (408) 594-1403 PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCLAL JOB DESCRIPTION: 1 ST AND 2ND FLOOR BATHROOM REMODEL (132 S.F) Sq. Ft Floor Area: I Valuation: $14000.00 "N Number: Occupancy Type: 342 56 023 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende 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 of Applicant: Date: 4/4/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 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, ftapter 9.12 and / he Health & Safety Code, Sections 25505, 533, an Owner or authorized agent: Date: 4/4/2017 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 I understand my plans shall be used as public records. Licensed Professional CUPERTINO ❑ NEw CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(�cuDertino.org ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION ! DEFERRED ORIGLNAL PERMIT f PROJECT ADDRESStOu, I •4P _ 5(o - 0 2- 3 O,w) ERI AAL YO _f � f v PHONE .a ®Q �� E'•i4IL �lS 0110"1� � / G{ Yvlivl I. STREET.••,DDR SS CITY, STATE, ZIP FAX CONTACT ? .AI E v�u'l !�C fJ /fPHO n q� � q LC - 4 4 o E-Ni4IL �/�a• CZI�n STREET DDRESS j C � / 4 A J CITY; STATE, 1'}j c C FAX El OW7.'ER ❑ oV, NER-BUIL DER ❑ OWNTERA•GE\T ❑ CONTR ACTOR ❑ COI.TR4CT/O�RVA✓GEi`T ❑ ARCHP'ECT ❑ ENGL�'EER ❑ DFvELOPER ❑ TE1:A\'f CON714CTOR NAI\4E LICE- N Ti R LI C,,M'S� T1� PE BUS. LIC r -L co, \SPANY"AuE e C� E-1 AL I �J FAX�azx•-w��.. �� (�.Y�kvo . eo STREET.417DPESS I�(C�. A6Go4 Ave- CITY; STATE, ZIP s,�jpI n (-/raj J (-/F} PHO t �(� ARCHITECT/E? GNEER NA1,4E LICENSE \70\4BER ' BUS. LIC -.1 CCMPANY NAI\4E E_AiAIL FAX s STREET ADDRESS v I CITY, STATE, ZIP - — I PHONE DESCRIPTION OF 11+ORI: L_ 0,,' GAIL 4,,mak' 1S S e EXISTNG USE PROPOSED USE CONST& i'YPE a STORIES USE TYPE I OCC. I SQ.FT. VALUATION (S) EXISTG AREA _ 2- NI',+FLOOR AREA ) 2 2 DEMO AREA (52-1 l 52— J TOTAL `� "] NTr AREA J C_. Q�f y eLis` kv I J 0 BATHROOM 1- CHEN OTHER R22\40DELAREA I R.r.,,40DELAREA REb40DELAP.EA PORCHAREA DECK AREA TOIAIDECKPORCHAREA GAR:GEEAREA: []DETACH ❑ ATTACH I �� DWELLING U\2TS: - IS A SECOND UNIT ❑ YES SECOND STORY ❑Y ---S BEING ADDED? ❑ NO ADDITION? ❑ No i PRE=,PPLICATIO'_d'❑TSS IF YES; PROVIDE COPY OF IS THEBLDGAN' ❑YES `NO _.F.E._ I�'x.D,B,Y:;<:` .::.:::.: .":.. , ' • "_=[ --:_,``ti: :-�s"-:=::`r•' TAL 4ALU. 110N. -- '?_' " '`�`,:`::'` PLA\NTNG P.PPL = FINO PL.4\-\NG.4PPRO1C4L LETTER EICHLER I30AIE? `" °- By luy signature below, I certify to each of the follov,+ine: I ani the property owner or authorized agent t6 act on 1he property mvner-s behalf. I have read this application and the information I have prow, d is correct. I have re the D ption of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' constructio Iau re . ec_ tatives of Cupemno to enter -the above-identiBed property for inspection proposes. S i anature of ApplicantlAgent: Date: 1. w - 4 •- f �-- ', : i SUPPLEMENTAL I FOR ZATIO?\ RE :..:::.- _:..�..,: ;:::_:_- .,,E -..,.::�.d::• ,[=; `;::; .i?:•::a° :'' pL�N CHECI� TIPS' : > [:zr:-.-A ROL1I �G SLIP„ ..... . r demolition , r 1 v 1 � 11 for ..nnitrer 1\e1t SFD o. Mu.�Ifa1n11� d1 ..IIIn_s. Apply ,o P New existing building s). Demolition permit is required prior to issuance of bu 1dinQ ' :.:<.. f et1+ building. permit for _ - Commercial Bldgs: Provide- a completed Haza,00Ln !\�atenals DlSclosure '..`LJ-i:'STAR-DARD:i c;' _°�:•=' :raj=^_'_:';': yi ::1_L:Pt'BLIC\i RI: =";":? • =t'I': =' -=i_'=.=: _ -erin ifany Hazardous ?t,�te, Iain are ban used aspart Ofthis project. - +a�:i: LARGE<;:;`_'• -:; <: :�':::;;';: c':�-. ,: ::�: FIRE DEPT" =I^ ;':':`':'.'' -` � ; =' �t'=`-i{r Co v of Plannmz ADDroval Letter or Rie.,t_r.Q with PIannmg -nor to `':: " iiJOR;- y__:' -':I r'ss? :<=sl •`- .SIiART.SE:�::I• RI I Lion. Ion.submittal ofBu Idm Permit a Ica ::,,.:... ..<...,. -- - = - •' •-' - _ _ _ -- - - _ - - - "�'E,'�1 BldaApp_?011.doc revised 06121:11