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B-2017-1204CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1204 10173 EMPIRE AVE CUPERTINO, CA 95014-1204 (326 24 06 1) FOUR SEASONS CONSTRUCTION AND SERVICES SAN JOSE, CA 95122 OWNER'S NAME: CHEN DIANLI AND ZHONG CUIYING TRUSTEE DATE ISSUED: 07/24/2017 OWNER'S PHONE: 650-279-4728 PHONE NO: (408) 398-0814 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #991832 Contractor FOUR SEASONS CONSTRUCTION AND SERVICES Date X BLDG —ELECT —PLUMB 03/31/2018 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 JOB DESCRIPTION: license is in full force and effect. KITCHEN REMODEL (95 S.F.); BATHROOM REMODEL (50 S.F.) REV #1 - REPLACE WINDOWS (5) LIKE FOR LIKE TO MEET I hereby affirm under penalty of perjury one of the following two declarations: EGRESS; REPLACE DOOR (1) 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. �i I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area• Valuation: $32000.00 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 APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 326 24 061 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertig cmpaf'C`ode, Section 9.18. Issued by: Abby Ayende Signatu Date 08/08/2017 Date: 07/24/2017 OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 08/08/2017 contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 2. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12' and the Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous a. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipmen t or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, Chapter 12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 2 .Oi4. exemption, I become subject to the Worker's Cpmpensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agegP be deemed revoked. Date: 08!08!2017 APPLICANT CERTIFICATION 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 Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in 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 Professional Signature Date 08/08/2017 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 • buildin cu ertin ISIO# ❑ ADDITION ❑ ALTERATION / TI eREVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS t C t A 3 � /- 1► V `. APN # OWNERNAME 3/w TO V `Z`� PHONE (610), '1701-147 �j "'V Jia. E-MAIL STREET ADDRESS �� ` in S` �� ✓ CITY, STATE, ZIP �� _/ C I ,• 17 A/VI FF CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ��t-,� n— MsomrV LICENSE NUMBER as f L 9 -f ` V ,7 L LICENSE TYPE BUS. LIC# 463382 COMPANY NAME F:6, 5 C"5 ,, �ZI�;S E-MAIL FAX STREET ADDRESS !NI Kms ' owl( f� I l CITY, STATE, ZIP 1�SA CA PHONE (40tr 3011-oriq I Y ARCHITECT/ENGINEER NRME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE i DESCRIPTION OF WORK I 5, i nv nv3 rr EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. , VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM! KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: U DETACH I []ATTACH I #DWELLING UNITS;; . IS A SECOND UNIT ❑YES SECOND STORY ❑YES _ BEINGADDED? []NO .ADDITION? []NO ,"��i ;I PRE -APPLICATION ❑ YES j IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ;', RE D,B 7 :. '"� c _ TOTAIs� VALUATION: PLANNING ADPL # ❑ NO PLANNING LETTER EICHLER HOME? ❑ NO _ �3$oa By my signature, below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have readd4wPescription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin s orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicani/Agent: Date: / c! 1 I SUPPLEMENTAL INFORMATION REQUIRED _ pI AN CHECK�TYPE _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ BUILDING existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER PLAN REVIEW permit for new building. EXPRESS ❑" PLANNING PLAN REVIEW - Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD + ,, A ❑ RIIBLIC WORKS, s _ form if any Hazardous Materials are being used as part of this project. x ,° Q LARGE x r" , ❑ FIRE DEP�1 } _ Copy g of Planning Approval Letter or Meeting with Planning prior to PP g g P _ ❑ � ' `❑` SANITAR'Y submittal of Building Permit application. MAJOR ` +r�`r SEWER DISTRICT' ❑,,-ENVIR0NI4IENTALIiEALTH,;`t .,. BidgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1204 10173 EMPIRE AVE CUPERTINO, CA 95014-1204 (326 24 061) FOUR SEASONS CONSTRUCTION AND SERVICES SAN JOSE, CA 95122 OWNER'S NAME. CHEN DIANLI AND ZHONG CUIYING TRUSTEE I DATE ISSUED: 07/24/2017 OWNER'S PHONE: 650-279-4928 PHONE NO: (408) 398-0814 II 0IDRM8lx s\ mmej olws13 X01 W41t:mvy V 11ml License Class a Lie. #991632 Contractor FOUR SEASONS CONSTRUCTION AND SERVICES Date 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. I hereby affirm under penalty of perjury one of the following two declarations: m. 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 eopf 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 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 ranting of this permit. Additionally, the applicant understands and omply with all non -point source regulations per the Cuperti nicipal Code, Section 9.18. Date 7/24/2017 I hereby affirm that I am exempt from .the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). [ hereby affirm under penalty of perjury one of the following three declarations: m. 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. 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. 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 shah 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. BUILDING PERMIT INFO - BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION REMODEL (95 S.F ); BATHROOM REMODEL (50 SX) Sq. Ft Floor Area: I Valuation: $32000.00 APN Number, Occupancy Type: 326 24 061 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Abby Ayende Date: 07/24/2017 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: 7(24/2017 7ERINGS TO BE CLASS "A" OR BETTEI 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, Chapter 9.12 and the Health & Safety Code, Sections 55 5, 5 Owner or authorized agent: _ 0ate:7124/2017 CONSTR TION 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 1 understand my plans shall be used as public records. Licensed Professional Signature Date 7/24/2017 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.oro e7 ry b-bJ14- tM ONEW CONSTRUCTION ❑ ADDITION uALTERATION/TI n REVISION/DRFFRRF.n nRlaTMAI PPPT,,HT�9 PROJECT ADDRESS 0 i y� r!'� A, Y!C APN # PHONE )) n OWNER NAME SA.S 0'h L ,Q O } Z'?�( • 4'TZ E-MAIL / STREETADDRESS 2Gp C�3(,__v 5 CITY,•STATE,ZIP Me%%4%I�{J V(J FAX CONTACT NAME TT- i' PHONE ,Y` 'N� E-MAIL Sww�L o►s LAK �-Pc.c.w�r STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER 11 OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Sa./ww i`f� LICENSENUMBER OJZ LICENSE TYPE rj BUS. LIC# COMPANY NAME FiilMr S4f/t��CMS �i�isTt E-MAIL 4wrs"so �5r 1146w 1 -nkv .FAX. STREET ADDRESS CITY, STATE, ZIP PHONE z1 3 iu►ll Rpt• t S 5ayX C,A. 01IMS (409) 3Jt,0r14 ARCHITECT/ENGINEER NAME. LICENSE NUMBER BUS. LIC # r � /y. 3 T I COMPANY NAME E-MAIL FAX "'�,/ D STREET ADDRESS - CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 4; EXISTING USE PROPOSED USE - CONSTR. TYPE # STORIES -- - Y USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM_{ KITCHEN �� 15'r OTHER - - REMODEL AREA l P S � REMODEL AREAREMODEL AREA . PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE. AREA: DETACH - - ❑ ATTACH DWELLING UNITS: IS A SECOND UNI T DYES SECONDSTORY ❑YES BEINGADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES R LIVED BY r TOTAL VALUATION: PLANNING APPL# E] NO PLANNING APPROVAL LETTER EICHLERHOME? NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on he property owner's behalf. I have read this application and the information I have provided is correct. L h the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin co on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent: Date: 412.411 SUPPLEMENTAL INFORMATION REQUIRED . r -AN'cHE T"r> _� xai3zlts>r �I New SED or Multifamily dwellings: Apply for demolition permit for ❑ O VER THE COUNTER © BUILDING FLAN REVIEW t existing buiIding(s). Demolition permit is required prior to issuance of building r: permit for new building. ❑ `_IZEss _� ❑ Pi wvNING r1 AiSaESw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure susL ❑ STAIjDARll i ❑ leolLs form if any Hazardous Materials are being used as part of this project. j ARGE „ g 4 - ❑FIRE DEFT ` Y x". Copy of Planning r Meeting with Planning prior to ttal of Building Permit application. ❑Aron❑riNTTARY sw> R DIST RICA . .. . . - ❑ .ENVIROIV1GtENTI1L�IiEAI.'TH ..,....;:.-' BldgApp_201 ].doe revised 06/21/11