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B-2016-2117CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2117 19339 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 114) DEVCON CONSTRUCTION INCORPORATED MILPITAS, CA 95035 I OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC I I DATE ISSUED: 06/13/2016 OWNER'S PHONE: 408-639-9322 1 I PHONE NO: (408) 942-8200 License Class B Lic. #323-16-3 9163 Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2017 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. hereby affirm under penalty of perjury one of the following two declarations: t. I have and will maintain a certificate of consent to self -insure for Worker's ^, ompensation, as provided for by Section 3700 of the Labor Code, for the % pcerformance 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. 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 and state laws relating to building construction, and hereby 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 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Sig Date 6/13/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: >. 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. 2. 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of 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. 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 and state laws relating to building construction, and hereby 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 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 611312015 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: I. - MODIFICATION OF DOOR HARDWARE; ADDING CARD EADERS-APPLE Sq. Ft Floor Area: I Valuation: $6300.00 APN Number: Occupancy Type: 31620 114 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF P�ERMIT ISSUANCE OR 180 DAYS FROM LASE SP CTION. Issued by: Alex Vallelunga -` Date: 06/13/2016 r RE -ROOFS: All roofs sball be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date:16/ 3/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505 25533, and 25534. Owner or authorized age Date: 6/13/2016 O T TIO Y I hereby affirm that there i en ing agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408),777-3228 - FAX (408) 777-3333 • building(a)cupertino.org n — ^`1 Imo" !w e NEW CONSTRUCTION ❑ ADDITION LYJ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS; ` C ^ APN # � ] / — ' / Ole— /r — J1( LOWNERNAME Z` 7 V i PHONE � '1 /32�r (�/ E-MAIL' STREET ADDRESS / CITY, STATE, Z'9 / FAX CONTACT NAME PHONE /av' �3�• �� E-MAIL � / • STREET ADDRESS CITY, STATE, ZIP to FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT E2 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ',� LICEE VUMBER LICENSE TYPE BUS. LIC # �N- ` E COMPANY NAME E-MAIL FAX s evto - an ar, STREET ADDRESS CIT S� E� I g PHONE ®n� •3�� n ARCHITECT/ENGINEER NAME�y LIC EDISE NUMBER. -- BUS. LIC # — 'AkJ ^0 COMPANY NAME bray E-MAIL i/A�� 5 � • �-dh2 FAX a STREET ADDRESS v� w.CITY, STATE, ZIP �+ PHONE DESCRIPTION OF WORK-�A�,�' ��s � � f �� '�� j�1�� % • EXIST G USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. ($} Q Z ��s�I►y 4--Q ® ❑ STANDARDS, PtiBLIc woRxs __ form if any Hazardous Materials are being used as part of this project. —VALUATION EXISTG NEW FLOOR DEMO TOTAL IRE DEPTI' Copy of Planning Approval Letter or Meeting with Planning prior to `,-MAJOR, ❑ SANITARY St ER DISTRICT: AREA AREA �� AREA 15} NET AREA X T: ❑`;ENVIRONMENTALAEALT'iI3: BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: F_1DTTAACH n I # DWELLING UNITS:I IS A SECOND UNIT U YES SECOND STORY U YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REGENED TOTAL };ALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO Lo By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on Ne propel owner's behalf. I have read this application and the information I have 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 to build" ct' u a representatives of Cupertino to enter the above-#ntijied property for inspection purposes. Signature of Applicant/Agent: Date: i1 `/ G _ New SFD or Multifamily dwellings: Apply for demolition permit for " y ? OVERTHE-COUNTER VI BUILDING PLAN REEW existing building(s). Demolition permit is required prior to issuance of building ` permit for new building. 0' EXPRESS ' ❑ •PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARDS, PtiBLIc woRxs __ form if any Hazardous Materials are being used as part of this project. U ❑ LARGE',12,, IRE DEPTI' Copy of Planning Approval Letter or Meeting with Planning prior to `,-MAJOR, ❑ SANITARY St ER DISTRICT: submittal of Building Permit application. , X T: ❑`;ENVIRONMENTALAEALT'iI3: B1dgApp 2011.doc revised 06/21/11