B-2016-1783 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1783
10100 S DE ANZA BLVD CUPERTINO,CA 95014(369 01001) CUPERTINO
PLUMBING INC
SAN JOSE,CA 95124
OWNER'S NAME: ZANKICH MARTIN TRUSTEE DATE ISSUED:04/18/2016
OWNER'S PHONE:408-253-0618 PHONE NO:(408)253-0618
LICENSED CONTR TOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#624905
Contractor CUPERTINO PLUMBING INC Date 04/30/2018 X BLDG _ M
ELECT X PLUB
_
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing ARCH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPAIR AND REPLACE BUILDING DRAIN INSIDE AND OUTSIDE
I hereby affirm under penalty of perjury one of the following two declarations: TBE BLDG(TOTAL LINEAR FEET 26')
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.
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:$10000.00
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 369 01 001
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
so a regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
X
ignature Date 4/18/2018 Issued by:Abby A ev nde
Date:04/18/2016
OWNER-BUILDER D R TION
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)
z I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/18/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 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. 1 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 Munici Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safe e;Sectio 3 5534..
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. O r or authorized agent:
APPLICANT CERTIFICATION (-Date.-4/18/2016
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9,18. 1 understand my plans shall be used as*public records.
Licensed
Signature Date 4/18/2016 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
LUPI:R 1Nf (408)777-3228 FAX(408)777-3333•building(a-cupertino.org Isc
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PLUMBING ❑MECHANICAL ❑ELECTRICAL El MIS(
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OWNER NAME �? P�IOI�'E �, E-MAIL
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STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS Ia t� CITY,STATE,ZIP FF
❑ OWNER ❑ OWNER-BuiLDER ❑ OWNER AGENT 13 O TRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME L LICENSE NUMBER r, LICENSE TYPE BUS.LIC#
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COMPANY NAME(2 t E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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 PROJECT IN°wItiDER:-n "-`—11 YE$.' 'PROSECT IN -❑-YEs :--IS TFC BLDG-AN- -.. .__❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
e'-_Y
TOTAL VALUATION: M)
By
RECEIVED BY. <;
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 b al£ I have read this
application and the information I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
—SignatureofAppiicanitAgent: '— Date:
,WPPLLM8TT5T_ALTNF0RMATWN REQUIREDr
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BUILDING DI ISI'ON'3 CUPER INO
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This set of plans and speci `catio: MUST be l ept at the
job site during construction. lawful to ake any
changes or alterations on same, or to eViate �
therefrom, without approval from the Building Official.
The Stamping of this pian and specifications SHELL NOT
be held to permit or to be an approval of the ioiation s1—,
of any provisions f anyty Ordinance or State Law.` 1
BY
DATE 14
PERMIT# 201 -