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B-2018-0016CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0016 10705 MINETTE DR CUPERTINO, CA 95014-3614 (375 32 044) UNIQUE CONSTRUCTION at REMODELING SAN JOSE, CA 95128 OWNER'S NAME: LAU MICHAEL LAND VICTORIA J i IDATE ISSUED: 01/04/2018 1 OWNER'S PHONE: 650-279-4260 1 I PHONE NO: (408) 706-4121 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #1914.281 Contractor UNIQUE CONSTRUCTION & REMODELING Date 06/30/2018 1 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 farce unit effect. I hereby 911rat under penalty of perjury one of the following five declarations: W„tea K ve and will maintain a certificate of consent 10 self -insure for Worker's ipeasalion, 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 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 slate 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. Date 114/2018 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following five reasons: 3. 1, 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) z 1, 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 or perjury one of fire Following three declarations: r. 1 have and will maintain a Certificate of Consent to self-iusmre for Worker's Compensation, as provided for by Section 3700 of the Labor Code, far 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. f 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 1 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 properly 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. � ZIKGG) BUILDING PERMIT INFO: X BLDG ELECT —PLUMB MECII X RESIDENTIAL COMMERCIAL DESCRIPTION: {ROOM REMODEL - (t20 SQ) LIKE FOR LIKE Ft Floor Area: I Valuation: $15000.00 APN Number: Occupancy Type. 375 32 044 PERMIT EXPIRES IF WORK 1S NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Jasmine At RE -ROOFS, All roofs shall be inspected In to any routing union ial being installed. If at roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofApplicaot Date: 1/4/2018 BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California li & 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 at- handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants its 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, Section 25505, 25533, and 25534. Owner or authorized agent: _ Date: 1/412018 CONS'IiR I:ION'L''NDING 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building@cupertino.ore PEMIT#E-'2015 0 G61PERTIN0 REV# DEF# ❑ NEW CONSTRUCTION []ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROHCTADDRESS I. _ P N j� lqe(`) lj 1(C� l/ OWNER NAMEIV\�8� 11rM `Ql/I PHO �AAPN##(� If dU` L�/�/'C/O 1 ��/j H --MAIL ,1^/f!^I�AI C#!CC/ `r `L.L�V`� (f STREET ADDRESS CITY, STATE, ZIP .%A 1 ylr!-e' p',ry / O! CITY, [L/� (©%8 � /Ml/ lER'VG( ❑ CONTRACT�',tO/R� (NAME ❑ O-BUILDHR C ©Illy J I'A D ee n e � t& ,S 4 PO C. ll> 1. ) LICENSE TYPE B STREETADDSS a a CITY{STATE, ZIP ,b ' H -MAIL BU . IC # r „. J 0 ARCHPPECT O OWNER O OWNER AGENT 0 CONTRACTOR AGENT ❑ ENGINNEEER 0 DEVELOPER ❑ TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIP'TON C9 i ❑SINGLE-FAMILY/DUPLEX ❑MULTI -FAMILY ❑INDUSTRIAL ❑COMMERCIAL USE TYPE OCC SQ.PT. VALUATION L'XISTINGUSB EXISTINGSP NeWFLOORSF PORCHSF DECKSP DEMOSP STORIES# TOTAL NET SP REMODEL RATI IROOM SF REMODEL KITCHEN SP REMODELOPHR SP GARAGE 0 ATTACHED SF D DETACHED EXISING ❑ YES FIRE SPRINKLERS D NO EICHLER 0 YES ❑ NO I SECOND STORY ADDITION O El NO DWELLING UNITS# SECONDDWELLING DYES DATTACHEDODETACHED OTHER UNITADDITOM ONO SF POOLS0 FIBERGLASS 0 VINYLLINED0 GUNHE 0 PREFABRICATED POOL -SF SPA - SP SPA ATTACHED DYES 0 NO TOTAL -SP Cornn mciul orM lfi-Fm r'1g8fildirrgs w'tl Pu6f'c Sw'm irg Pools,equi'es Deportment ofEnvivanmmmnl HenN npprovrnl I]EIVED BYETOT T. VALUATION: RE -ROOF EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ ASPHALT SHINGLES❑WOOD SHAKES E] WOOD SHINGLES TILE CNER(SP Y) REMOVE /REPLACE ❑NO ❑ YES ONO # OF LAYERS PLYWOOD ❑H' ❑3/8" TTTICKNHSS ❑ 5/8" OTHER - PLYWOOD TYPE: I ❑ OSB ❑ CDX OTHER PITCH - • 12 ROOF CLASS A PROPOSED ROOF TYPE: OBDILT-UP ROOF DASPHALT SHINGLES 11 WOOD SHAKES OWOOD SHINGLES ElOTHER *Provide a signed copy of the Cupertino's Tear -Off Policy SF #.fSQUARES 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 read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and ate laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection pu oses. I acknowledge mid authorize all information contained on this application form to be made available for public record. Signature of Applicant/Agent: _— Date: SUPPLEMENTAL INFORMATION RE RED --.— *New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form 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. *HOA -Provide a letter of approval from the Home Owner's Association B1dgApp_2017.doc revised 08101117 eog