B-2016-1726 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1726
10370 ALPINE DR APT 1 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 RESEDENTLAL_ — —
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 2 FURNACES,SAME LOCATIONS
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
0--phav
erformance of the work for which this permit is issued.
eand 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:$4000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 32615 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 pplicant understands and will comply with all non-point
source regulati ns per the Cupertin Municipal Code,Section 9.18. 180 DAYS FROM LAST CAL + SPECTION.
Signatur'r 6 / rt Date 04/0.8/2016 Issued by:MELI
Date:04/08/2016
OWNER-B DER DECLARATI N
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
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)
2. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
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. 1 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,Seiltions 25505,2553 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:04/08/2016
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
relating to building construction,and hereby authorize representatives of this city t is issued(Sec.3097,Civ CJ
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 DFCLARRNUON
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
Signature Date 04/08/2016 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333 building(a)-cupertino.org
CUPERTINO
ISC
r3- Z'0 t.6 - t
M
PLUMBING NMECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS . I &/J
/037/-) AI F n AVe_ / APN# ,6 15-dV
OWNEAbdF
PHONE
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n ` f3fX5 — 7Q / ' 90 c .&lcf ®!
STREET ADDRESS--/10 / )y► �Grl� CITY, q -` FAX
bT'f
CONTACT NAME YCITY,
Htee®
STREET ADDRESS STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
0jeza 7tv, 7 ago
COMPANY NAME E- IL
�� NAP l� t (r�1t' � � , CU✓j1 FAX
STREET ADDRESS 4 y & p`� CITY,STATE,ZI/y / ,ry � PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE;ZIP PHONE
USE OF ❑SFD orDUPLEX MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESC R ON OF WORK
V 4 06'(4 C, 0 ilL
TOTAL VALUATION: `®r� 1 TSE
lO c
By my signature below,I certify to each o he following: I am the property owner or authorized agent t e pr ner's beha�If _d this
application and the information I have r vided is correct. I ave read the Description of Work and verify it is acc rate. I agree to complycable local
ordinances and state laws relating to ding c fIs ctio authorize representatives of Cupertino to enter the above-identified prope purposes.
Signature of Applicant/Agent: Date: !�
o ,
SUYPLEMENTAL INFORMATION REQUIRED
44
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