B-2016-1728 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1728
10370 ALPINE DR APT 3 CUPERTINO,CA 95014-0916(326 15 076) COLD CRAFT INC
LOS GATOS,CA 95032
OWNER'S NAME: EAST ENTERPRISES LLC ET AL DATE ISSUED:04/08/2016
OWNER'S PHONE:408-761-3678 , PHONE NO:(408)374-7292
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT'INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#631837 X BLDG ELECT _PLUMB
Contractor COLD CRAFT INC Date 11/30/2017
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE,SAME LOCATION
I hereby affirm under penalty of perjury one of the following two 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
1AL,formance 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. Sq.Ft Floor Area: Valuation:$3000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 15 076
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulati hs per the C pertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED CTION.
Signature 1��-® Date 04/0.8/2016 Issued by:MEL
Date:04/08/2016
O -B DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1.. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/08/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&'Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec'ons 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall /V/
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:04/08/2016
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
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
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 04/08/2016 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUP EtT C3 (408)777-3228•FAX(408)777-3333• building(U-)cupertino.orqIsc
.
Q- 2® 6 1 �Z
[]PLUMBINGP'
MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 7A �p �, � e
OWNER NAMEAs7\icr t En f 4 A I f!"�L.J� PH��(3 E�fs�{S� [7C
STREET ADDRESS 7® A/ J.,0 rg CITY, STATE,ZIP /! Q J`�� s�. � ; AX
CONTACT NAME � � PHtf6 � 7o? E-MAIL
STREET ADDRESS CITY,STATE,ZIP / V•! FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 17 /v v LICENSE NUM [ LICEN_SE TYPEBUS.LIC#
( � [ C _ /
COMPANY NAME
/
FAX
STREET ADDRESS 6 / `p / /� CITY. !Tm /�� J PHON jQg` �,f
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROSECT IN WILDLAND ❑ YESPROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑-NO EICHLER HOME? NO
DESCRIPTION OF WORK
4' a 1014 Z16 12 k I? )ev
t
TOTAL VALUATION: /��
Y.
v �- .! _ a•..
a
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property own ve read this
application and the information I havep,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 t bbildin -o.onstructi, I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: - Date:
SfJPPLEMENTAL INFORMATION REQUIRED t '
� C1tk2L�"ICO'CJh7 „1
9
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