Loading...
B-2016-1304CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: H-2016-1304 7414 TIPTOE LN CUPERTINO, CA 95014-5819 (359 32 060) ( DOVETAIL DESIGN AND CONSTRUCTION) CUPERTINO, CA 95014 OWNER'S NAME: LORD ROY S SR AND LEANNA TRUSTEE DATE ISSUED: 02/04/2016 OWNER'S PHONE: 408-255-2860 PHONE NO: 415-378-5989 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO; License Class Lic. # ;a Ce2[s8`-9 -I-- Contractor ( DOVETAIL DESIGN AND CONSTRUCTION) Date X BLDG —ELECT —PLUMB 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 license Is in full force and effect. SOB DESCRIPTION: REMOVE (E) MASONRY FIREPLACE AND INSTALL (N) ZERO I hereby affirm under penalty of perjury one of the following two declarations: CLEARANCE FIREPLACE; REMOVE (E) HEADER AND REPLACE r. I have and will maintain a certificate of consent to self -insure for Worker's WITH FLUSH BEAM; RELOCATE KITCHEN (169 SF)AND Compensation, as provided for by Section 3700 of the Labor Code, for the BREAKFAST AREA (94.5 SF); RELOCATE 1 WINDOW AND REPLACE performance of the work for which this permit is issued. 2 WINDOWS; RELOCATE GARAGE MAN -DOOR, WATER HEATER, z7 I have and will maintain Worker's Compensation Insurance, as provided for AND WASHER/DRYER, 7 'by Section 3700 of the Labor Code, for the performance of the work for which Sq. Ft Floor Area: Valuation: $75000.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 359 32 060 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, =FB.Issued ),o by; 1979 SData 2??� i Date: RE -ROOFS, OWNER-BUrLDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Low for one of the All roofs shall be inspected prior to any roofing material being installed. If a root' is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 2. 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 (See.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I 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 California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the pe:fomance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued, I material, Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area At all Management District I ' will maintain compliance with the Cup er u M untold e, Chapter 9.12.and Worker's Compensation laws of California. If, after making this certificate of God e[io s 05, 25533, id 25534, the Health &YSTZ4fGCTION 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. Owner or authorized — Date; !L Jq ((-,e APPLICANT CERTIFICATION CLENDING AGENCY I certify that I have read this application and state that the above information is 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 mentloned 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 ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCa cupertho.org �NHw cnxn sTRcrrnN n AnnTTTON AT.TRRATION /TT n REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS APN K OWNER NAM,� — Iro4< P,jtq�IE E-MAIL STREET ADDRESS 1 f'rra Ir ( CIT eTATE, ZIP GJPep—r-faci CA "ISoI FAX CONT�c T NAME ^Jeri- .�-yl.,c:- P 30 NE�15•3'7 ,y�. E MAIL J�u.i.Gfvr>EIL..tY=, Cc�✓�t STRITnDRESS `ltz" f TY, STATE, ZIP v�r> ic7 C!9 fi5ery F `fbf5L5�•3�`I ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 0-'CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C' CTOR AME LICENSE NUMBER LICEN,$'E�TYPE BUS. LICK o. �'LGFLJlL— gbltp COMPANY NAME �� E-MAIL a F 337.1 1�J = 1 3 : Co u.. 7�aJ tnr� na t5Ti2 cr lv ( �°t • GiS' MEADDRESSCI 'TifTvc 'Y, STATE, ZIP P ONE Is:3vsH�� w. CD�EEn<ta,� �Svl` ARCIIITECT/EN NEER NAME LICENSE NUMBER BUS. LICK I?eLWL5 4'ENFa.--- — ---- — C llifit5 --- - COMPANY NAME' E-MAIL FAX SNH PIT %i IZC I TGL-`f .SHAi2 .:.A0 5 8G Gl.n 3/1 L • Ott I STREET ADDRESS )oTb r�. EIL fA Ile, Alt:- TY, STATE, ZIP A 6 Sot HONE DESCRIPTION OF WORK I'vNCJdV Fi—i YislSc,.,iS ><eLisa.ti�—", i.l$nui il. S e�b Cl4=/ZeAj J.(,!-. %•12uJ� Ka AL`ti ✓L_ k-'w�/I ita S.r2 ' £ 100 i<I GNF 11 _ _/ % W tip �.PLhc� Z w%.+`b•a �� .. EXISTING USE PROPOSED USE CONS TKTYPE r0RIES USE TYPE OCC. SQ.FT. VALUATION(s) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA�RF.MODELAREA POACH AREA DECK AREA TOTALDECKRORCHAREA GARAGEAREA: DETACH ❑ A ACH M DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY DYES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑YES 1F YES, PROVIDE COPY OF ISTHERLDGAN ❑YES I EDB TPTAL VALUATION: PLANNING APPLN ❑NO PLANNING APPROVAL LETTER EICHLGR HOME?❑NO -©Q -` By my signature bclow, I certify to each of the following: I am the property owner or authorized agent to act on the r erty owner's behalf. I have read this application and the information I have pr id rs enec . I have read the Description of Work and verify it is actor . I agree to comply with all applicable local ordinances and state laws re t11ig oil m onstmction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Ag- ,. Date: SUP? TAL INFORMATION REQUIRED pI„;N CHECK T?,TE ROUTING SLiP--I - ❑ OVER -THE couNTEix ❑ BUILDING PLAN IievTEw _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildntg permit for new building. ❑ EX'PREss ❑ PLn-NNLuc RLM REVIE\N= Conmiereial BldgS: Provide a completed Hazardous Materials Disclosure ❑ STUN mdUn " ❑ PUnL—c wbkkS . _ _ form if any Hazardous Materials are being used as part of this project, 0s, ❑ " LANCE FIRE nEpr _ Copy of Planning Approval Letter or Meeting with Planning prior to M.A]OR. ❑ -SANITARY SEWER DISTRICT: f submittal oBuilding Permit application. _❑ ENVIRONMENTAL HEALTH BldgAyv_2011.doc revised 06121111