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B-2016-2224CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2224 10121 N FOOTHILL BLVD CUPERTINO, CA 95014 (342 32 070) S B I BUILDERS INC SAN JOSE, CA 95126 OWNER'S NAME: FOOTHILL AUTO SERV & DETAIL INC DATE ISSUED: 06/28/2016 OWNER'S PHONE: 408-499-5302 PHONE NO: (408) 203-4397 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #$60997 Contractor S B I BUILDERS INC Date 06/30/2017 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: SITE PERMIT FOR LIVE WORK PROJECT - SEE P ERMITS 14090172 I hereby affirm under penalty of perjury one of the following two declarations: & 14090182 FOR PLANS 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: $0.00 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 342 32 070 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 IS DANCE OR Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LFSC/LED PECTION. dl, Signature'` - I Date 6/28/2016 Issued by: Alex Vallelunga Date: 06/28/2016 Iq OV*TNER-BUIL R DE LARATI 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 be' ag 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 of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 6/28/2016 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 DISCLO URE 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, 255 3, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Cod , 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 cor handle hazardous material. Additionally, should I use equipment or device which emit hazardous shall not employ any person in any manner so as to become subject to the 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, ons 25505, 255 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. s _ _,_ Owner or aathoriied_agent: APPLICANT CERTIFICATION Date: 6/28/2016 certify that I have read this application and state that the above information is CONSTRUCTION LENDING A I hereby affirm that there is a construction lending agen Cy y for the performance 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 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 DECLARATIO and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S I understand my plans shall be used as public records. Code, Section 9.18, Licensed Signature Date 6/2812016 Professional BldgApp_2011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE,AVENUE • CUPERTINO, GA 95014-3255 CUPERTINt ry�j (408) 777-3228 • FAX (408) 777-3333 • buiiding(a.cupertino.org �((j 01Q� 011Z ,LLNEW CONSTRUCTION ❑ ADDITION 0 ALTERATION / TI El REVISION /DEFERRED ORIGINAL PERNIIT I D ! O PROTECT ADDRESS I qgy/ V I I 11 `J p APN # O WNER NAME ` 6 / l h y - ,, `PHO 14 0 4 �y� D �/] E-0 1 `fit /_j { , / Q - 3� 11 !i 1f it l�N �i.1.V M a ry /� r°PGlri .(%{d I STREET,AWRFsa 22 sa - FAX JD� -- CONTACT NAME oh rCt+t H° i - M z ML9 *d(kith pwitnt. rbm SR�ETDRE V1 trvt . 21)& (V D r CU'sIJ S T' Z� J V J FAX OLW.NER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONMA t e LICENSE NUMBER �'� D /p /) l ILICINSEYPE COMP EU I Cil 1 t/• IL 443 q S�� C 1 ° t ®� s 1 FAX STREET ADDRESS 1 ki ( avvitdi l U o D CI I(iE I D �r® l S 0 Gib PHO m gg ARCHITECT/ENGINF,T NAME VI LICENSE NUMBER/I �' 1 BUS. LIC # COMPANY NAME ` M. 0 V E-MAIL. /� h �^ lri e mo . , VC® . • ft (M 1 FAX S D U 1s s! 1 ,-bh !\ vt - U frYfT&IP iJ P 4 l D O c3 N °- M DESCRIPTION OF WORK S, c -r a N slit sfrrs AM 1A, Hffif�Q L i l n h vi / EXISTING USE PROPOSED USE - CONSTR. TYPE -# STORIES - - - - - USE TYPE OCC. SQ.FT. VALUATION ($) "XI EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA " BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER - REMODEL AREA - 2 PORCH AREA DECK AREATOTAL DECKITORCH AREA GARAGE AREA: LJDETACH []ATTACH �6 # DWELLING UNITS: - IS A SECOND UNIT ❑ YES BEING ADDED? [-]NO SECOND STORY []YES ADDITION? []NO .• - - - - PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YESjIE{;EI EICHLER HOME? ❑ NO - sjot TOTAL V ATION: 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 behalf. I havi 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 ' E pplicable local ordinances and state laws relating to bui g o s c o ze representatives of Cupertino to enter the above -i en�t7fi(e�dToperty for inspec ion purposes. Signature of Applicant/Agent: Date: 0 �' SUPPLEMENTAL INFO ION REQUIRED I>ot sPi r �fkUT :SLIP �� IIILD#IC=PL >IEEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building u permit for new building. EMPRESS [AIlSYI? I1Qtr _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure3Tvnu YLi>#LIC tYf) farm if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to t n� submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11