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B-2016-2148 CITY OF UPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2148 10199 RICHWOOD DR CUPERTINO,CA 95014-3313(369 08 041) JOHN SULLWAN CONSTRUCTION INC CAMPBELL,CA 95009 OWNER'SNAME: ROBELL ALAN AND LAURIE A TRUSTEE DATE ISSUED:06/16/2016 OWNER'S PHONE:650-353-8720 PHONE NO:(408)247-2147 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#4 5236 Contractor JOHN SULLIVAN CONSTRUCTION INC Date 3 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 Cod a and that my license is in full force and effect. JOB DESCRIPTION: REPLACE STUCCO AT LEFT WALL OF HOUSE(243 SQ FT); I hereby affirm under penalty of perjury one of the following twodeclarations: REMOVE SIDING AT LEFT REAR WALL AND INSTALL STUCCO; t. I have and will maintain a certificate of consent to self-insi we for Worker's (120 SQ FT);REPLACE 2 BATHROOM WINDOWS Compensation,as provided for by Section 3700 of the Lab)r Code,for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insuranc ,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this ermit is issued. Sq.Ft Floor Area: Valuation:$5350.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the abov information is correct.I agree to comply with all city and county rdinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby autt orize 369 08 041 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep h irmless the City of Cupertino against liabilities,judgments,costs,and exper ses 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 on-point source regulations per the Cupertino Vynicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature l/v Date_Q/16/2016 Issued by:Abby&cnde Date:06/16/2016t/l'Y/�1 OWNER-BUILD R 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. I,as owner of the property,or my employees with wages a 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 int-ended or offered for inspection. sale(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting wi licensed Signature ofApplicant: contractors to construct the project(Sec.7J044,Business&Professions Code). Date:6/16/2016 / 6/2016 I hereby affirm under penalty of perjury one of the following three declarations, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. I have and will maintain a Certificate of Consent to self-in ure 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 Insuranc ,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 th 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 whichthis 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 becom 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 g 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,Sectio s 25505,2 3,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:6/16/2016 I certify that I have read this application and state that the abov information is CONSTRU ON 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 represen atives 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 purp ses. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino agal nst liabilities, judgments,costs,and expenses which may accrue against saic City in Lender's Address consequence of the granting of this permit. Additionally,the ap licant understands and will comply with all non-point source regulations per the Cu ertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date /16 Professional CONSTRUCTION PERMIT APPLICATION 4 COMMUNITY DEVELOPN ENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255' (408) 777-3228• FAX(40 )777-3333 • building uoertino.org CUPERTINO [:1 NEW CONSTRUCTION [:3 ADDITION ❑ . TER4TION/TI ❑ REVISION/DEFERRED ORIGD,AL PER11UT PROJECT.4DDRESS r© 9 �Q9 ��Jj_ / APNR OliRNTER NA1✓E STREET ADDRESS Sol M CITY, STATE,ZIP I FAX 1� CONTACT NAME /-a LA, P� PHONE 6s-0 3� ^�7� E-DtiAIL STREET ADDRESS p 4 '✓ vvv CI TY,STATE, ZIP FAX �R ❑ OWNER-BL-IIAER ❑ OMWERAGENT ❑ C NTR4CTOR ❑CONTR4CTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME wv \ LICE'SUT E N4BER LICENSE TYPE BUS.LIC" �ull� �3 -7a3�`�1 COMPANY NAME E-MAIL FAX STREETADDRESS So O PhV QCITY,STATE,ZIP �Q�� PHONE�lD��(�-12� 7 ARCHITECTlENGLNEERNA1,4E hf LICENSE NU14BER BUS.LIC 4 COMPANY NAME N r E-?\CkIL FAX STREETADDRESS I CITY,STATE,ZIP PHONE DESCRIPTION OF\\'ORI: ?D e4M�V, Nec a 4 _/(� ce 1e� /{ r_ ,q/J ^ ' '�Vv-'C/ iqld�CJ! T EXISTING USE PROPOSED USE CO;\TRQ YP 'STORIES USE TYPE OCC. SQ.FT. VALUATION(S) F%ISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL.AREA REMODEL AREA REMO ELAREA PORCHAREA DECI:AREA TOTAL DECK--PORCH AREA G P4GE AREA: DETACH I —— ❑ATTACH r DWELLING LTTTS: IS A SECOND UNIT ❑}'ES SMIND STORY [:]1'ES BEINGADDED? ONO ADDITION' [-]NO PRF-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE IT ED TOTAL VALUATION: PLANT-ING.4PPL' NO PLATTING APPROVAL LETTER EICTER HOME? '`0 ' By my signature below,I certify to each of the following: I am e property owner or authorized agent t act on e property owner's behalf. 1 have read this application and the information I have provided.is correct. I haread the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laivs relating to mildin-construction I aut orize representatives of Cupertino to enter the above-ideti,--d prop r 1ty.for inspection purposes. D Signature of Applicant/Agent: y ate: �j SUPPLEME TTAL INFORMATION RE IRED � M,w Q ,r F... ..7 L4\.CHECI.TI P,E< ,�, F ? ROlJTI\G.SL7P.'r ; New SFD or Multifamily dwellings: Apply for demo ition permit for © 0\ER TFE COII\TER ❑'BUILDI\G PI�4\RE1 IE existing building(s). Demolition permit is required prior t issuance of building k h x permit,or new building. ❑ EtiYR£SS y �c' az� ❑ PLS\\L\G PL4�RE}IE\6 z _Commercial Bldgs: Provide a completed Hazardous Taterials Disclosure :❑ sT \D4RD L^7 PUI3LIc\\ORho form if any Hazardous IM,aterials are being used as part of his project. g, c' g ❑�L4_RGE sg �' � �, ❑�Sp�REDEPT &� ,y� ' Copy of Planning Approval Letter or M=eting with Planning prior to submittal of Building Permit application. ❑ rz4aoR ❑ S4\IT4R1 SE\ ERDISIRICT ,; a ... a:r :❑E E\VIRO\1iE.\T.4L.73E.4LTH.+ :'.` E° Bldg pp_?011.doc revised 06/21/11 OPPROJE 'y*.C101y REMOVE SIDING & 1. REMOVE & REPLACE STUCCO AT'LEFT WALL OF HOUSE INSTALL STUCCO 27' x 9' = 243 Sq. Ft. 2. REMOVE SIDING AT LEFT REAR WALL AND INSTALL STUCCO t (� 15' X 8' = 120 Sq. Ft. 1'5 Slab l U L. TOTAL= 363 SQ. FT. OF PROJECT 3. REMOVE & REPLACE (2)TWO BATHROOM WINDOWS WITH i COMMUNITY DR ELODMENT DEPARTMENT TEMPERED�GLASSDIViSION-CUPERTINO _ APPRO a ED .Thi-set of pians and specifications MUST be kept at the joo,:sii:n during construction. It is unlawful to make any or alterations on same,or to deviate U thor:Yirom,without approval from the Building Official Ti3o of this plan and specifications SHALL NOT _ L:� to permit or to be an approval of the violation of er-.y p?ovisions of any City Ordinance or State Law. Z713Y ---- -- -- D AT E (.e- lIbi(p --- - 1. REMOVE EXISTING PERPAT NO. ©1[v-� � ❑ 3 STUCCO & INSTALL NEW PAPER WIRE {I G-a rDNI '� &STUCCO PUANNING DEPT" CW'PERTINO PROJECT ADDRESS: OWNER: .10199 RICHWOOD DRIVE ALAN & LAURIE ROBELL CUPERTINO, CA 95014