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B-2016-1825 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1825 10682 FLORA VISTA AVE CUPERTINO,CA 95014-1607(326 08 042) COMMERCIAL FACTORS INC DIXON,CA 95620-9208 OWNER'S NAME: AZARIAH SHALINI E TRUSTEE&ET AL DATE ISSUED:04/25/2016 OWNER'S PHONE:650-787-6518 PHONE NO:(800)614-7263 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GLAZING Lic.#Z82072 Contractor COMMERCIAL FACTORS INC Date 07/31/2016 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing 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 10 WINDOWS AND 1 SLIDING GLASS DOOR(ALL I hereby affirm under penalty of perjury one of the following two declarations: WINDOWS WILL MEET EGRESS AND BE TEMPERED WHERE t. I have and will maintain a certificate of consent to self-insure for Worker's REQUIRED BY CODE) 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 Y' permit is issued. Sq.Ft Floor Area: Valuation:$6449.00 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 32608 042 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 egulatiogns er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ?gnature � Date 4/25/2016 Issued by:ABBY AYENDE Date:04/25/2016 OWNER-BUILDER DECLARATION 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 t. 1,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 of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/25/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t. 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 1 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,Sections 25505,25533,ant]25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. caner or authorized agent: 'v- APPLICANT CERTIFICATION 44I ate:4/25/2016 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 4/25/2016 Professional l� �I�sG'�f11'1(' �,I�PL_]CA r110 B J' 1= 00,10MUN1T`I DEVELOPMENT DE?Fu=TMEN'T•BUILDING DIVISION 10300 TC.iRRE AVENUE®("UPE_RITNO, C;A==501 1-3255 ,I-tuJIPER 1,40 (408;1.77--3228, FAX(408)777-3333 build:na( r�ertino.orct ❑NEW CONSTRUCI701NI El ADDITION u AI.TERATIONI/Ti El REVISION/DEFERRED ORIGINAL PERMIT# 4 'ROJECT ADDRESS i, Q v� AI'N_g 3 Z,6 /C/'� y �.._....v.. ...._,....1:,...�,.� �t),uNER NAME YHON i E-MAIL Cod "TREET ADDRESS CITY, STA.rE,7-i FAX I hAL t CONTACT NAME �PI IONT E-MAIL i STREET ADDRESSCITY.STAT-_: 21 FAX I7 OWNER ❑ OWNER-BUILDER ❑ OWNERAGLNT qq CODITRACTOR ❑CONTRiCTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT �'GNTRACTORNAN[TN LICENSENT.MBER ,� LICENSE TYPE BUS.LICJq z ----- AM—_ _ 1 t .:OMPAT 7Y NAME E-M41', FAX --------—L1- — ------ -- ka?_ _ _ � iTREET ADD',2ESS �{��Jg �'r/`�� 4 �� CITY«TyI,I,ZIP j� `A� �yA' , � `J PHONE h• ti.r...:..J\ �. :1nSAI. .....1.��,.L�VV�► r ��l�l-4�✓® ,m._., V �� I wMkCHITTCT/ENGINEER NAME ICEDiSE Nti\•iBER BUS.LIC# j ('CNIPANY NANfE E-NIHIL FAX I i STREET ADDRESS C'ITY,,-TATE.71P PHONE i JESCRIPCION OF WORK ?:EYING USL- 1'ROPOSBD LSB 1. CONSTR.Tl'PE A ST02IES USE TYPE OCC. --SQ.Fi'. VALUATION(S) 'x ISTG NE\1'FLOOR DEMO f� TOTAL— --AV EA AREA AREA NET AREA .IATHROOM YITCHEN OTHER 4 ItENODELAREA �RFMODELAIiEA — REMODEL AREA — — f PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA.: E]DETA.CII ATTACH E. j DWELLING UNITS: IS A SECOla'D UNIT OYES SECOND STORY YES —� BEING ADDED? �NO ADDITION? ONO 1 c' ANNI G APPON L[]NO IF 1'KN PROV IDE C 0,L LE .ER IS THEBLDGHO AN `E]YES BY TO'CAL VALu - ON: f ''LANNING r\PPL t! ❑NO }') '.PNIP:G APPROVAL LETTER 6ICHLGR HOME? (�I'-.^�.,. e — � /.,�.`I1I1 � ©O . ®fay my signature below,I certify to each of the following: I am the property owner or authorizedyagent ro act on the pe vner's behalf. 1 have read this application and the information I have provided is correct. I have read the Description of`Mork and verify it is accura e. I agree to comply with all applicable local f ordinances and state laws rolating to building o struction. I authg;aze-representatiw.s of Cupertino to enter the above-identi led pr Pei for inspection purposes. `;i.-nature of Applicant/Agent: o — Date: StIPPLEME,flAL INFORMATION REQUIRED e��Nel�i�cTi�rE � uooTlNc_sLlr� __New SFD or Multifamily dwellings: Apply for demolition permit for cIuER e>tE COUNT R © l3UiLr1INGPLAVIu,VITW existing building(s). Demolition permit is required prior to issuance of building f ?ennit for new building. �� E?PRESS ❑:PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed I;acardous Materials Disclasure [_l STANDATip 0,1?I UBLKIvoRlcs I SomT if anv Hazardous Materials are being used as part oCthis project. FIRE)DEI?? Copy of Planning Approval Letter or tJteeting ywith Pia�wTing,prior tD submittal of BuildingPerr.Titapplication. C7 �,4NITA�YSEwERnrsTRieT ❑,13NVIRONb1 NTAL"HEALTH i oeen3t�m®®.ru.m-csmunn.nen.r.aruun�c+cucs�aur�nemx.e¢urs�anecnu�.�evuucu;.u.,mms:r.ena�n a�u. �n[oe®uAmiism anee VIIRON PldgApp_2011.doc revised 06/2/'11 340 Industrial Way, Suite T, Dixon, California 95620 MCI �� £ _ (800) 614-7263 FAX(707) 678-9973 www.newpane.com CA License#782072 PIS PLANS C ECKED BYYLA C1 LANNING DEPT CUPERTINO - b Q, e � J V J ` Pvt- Xv X0 Ci0MI'.'1! Ilei T y R'7-,,i r._� DULDINIG G T}!Ir t n Uday L y- r 0682 FLORA VISTA-IAyE,., ,� .r. os fh;� ,, _ - �T ` 9 PERTINO CA 9501 160,7 LL �' ',� ''icy ® 87 6518 cell _ o Un —6, PERMITIvo.0 - A`