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13080029 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6701 JOHN DR CONTRACTOR:ANDERSON PERMIT NO:13080029 INSTALLATION OWNER'S NAME: SAN JOSE,CA 95126 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11COMMERCIALE] License Class Lic.# 56'06'0 ( REMOVE AND REPLACE 5 WINDOWS AND 2 DOORS IN EXISTING OPENING-BEDROOMS TO MEET EGRESS Contractor Ande�sa� yhSTo//(,��Date �• 7_ r� I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 peyformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2100 ave 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 APN Number:36927056.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHINA80 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 VFOM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 3 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signatu Date 7 /2All 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. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6:95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:117 permit is issued. �> 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION C1 12 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 6011; 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �u$ C U P E RT I N O (408)777-3228•FAX(408)777-3333'building(a�cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS - 1a ✓1 APN# 2-7 ^t0 S/_ OWNER NAME � " STREET ADDRESS CITY,STATE,ZIP t FAX 01 q CONTACT„h1AME ' PPHONEE-MAIL Q )) . 1 STREET ADD SS- C ,STATE,ZIP a�_ FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT NaNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT h CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# JCC CO NY NA - -MAIL pj STREET ADDRE ` Y,STATE,ZIP -PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ' I , Je2 cicaa:�) FX c , EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVE T TAL VALUATION: PLANNING APPL# [:]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 64 /U0 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on t e 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 state laws relating to buil ' nstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Age Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of buiAffr permit for new building. ❑ EXPRESS ❑ ING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1-1STANDARD 1-1PUBLICWORKS Form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 51"54 U"nS ,Lo3o tJ rv,vs r Res, �{rh5e I 28C� 6*'() ' Jvh� �r►�t �LIO�nS �i�q� I S�ro��+9 l�t�o�w 6o o xa 60yo Re��J�e S �i��owsi AnJ �o dCXJ�l M�5�e� G),,� *,ul IiTY Dr-)21.OPME. f DE. C EUILDIi.G ilViSit7N-CUP ERh`�f dee+iouw. �T AppFIOJE,D L (/ Thi!'. set of plans and specifications MUST be kePt at the or alterations ontsameis 'aonstrUc orfto deviateul to any Official. without approval from the Building SHALL NOT nn of this plan and specific eroval'of the v olat on to permit or to be a pp oY any p,-0\jlsons of any City Ordinance Or,S�ate Law. tr r.-!: g- 0 ga neparbment , o AUG 0 6 2013 P4-P 0 O oo r T 606 )Co REVIEWED FOR COD COMPPLIANCE 3� uu.- Reviewed By. Mom ,ct, �6 U xu G C�✓e s s ��6,�s�` � I