B-2016-2230CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2230
19600 VALLCO PKWY STE 100 CUPERTINO, CA 95014 (316 20 108)
TES COMPANY
SANTA CLARA, CA
95050
OWNER'S NAME: CUPERTINO PROPERTY DEVEL I LLC
DATE ISSUED: 06/30/2016
OWNER'S PHONE: 408-343-1088
PHONE NO: (408) 605-2297
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ELECTRICAL Lic. #779016
Contractor TES COMPANY Date 05/31/2018
X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_
MECH X RESIDENTIAL _ COMMERC IAIL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
INSTALL WATER NEATER BRACKETS PER HEALTH
DEPARTMENT
I hereby affirm under penalty of perjury one of the following two declarations:
REQUEST - ICOOL
i.. 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.
,,,,,f
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.
Sq. Ft Floor Area:
Valuation: $3000.00
APPLICANT CERTIFICATION
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
316 20108
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 applican , nderstands and will comply with all non -point
-
source regulations per a upertino unicipal Code, Section 9..18.
180 DAYS FROM LAST CALLED
INSPECTION.
_ 30/2016
Signature Date 6/
Issued by: Abby Ayende
Date: 06/30/2016.
OWNER -BUILDER DECLARATIO
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 r
move 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: 6/30/2016
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 T
O URE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements u
ider 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,
5533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal
ode, Chapter 9.12 and the
e. 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 de
ces which emit hazardous
air contaminants as defined by the Bay Area Air Qualty
Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municip
A Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Se ns 2550 2
i533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.Owner
or authorized agent: A
APPLICANT CERTIFICATION _
Date: 6/30/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING
EN Y
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending aC
ency 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'SD AR
N
Code, Section 9.18.
I understand my plans shall be used as public records.
s.
Licensed
Signature Date 6/30/2016
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION
'10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
C PEEt't'IN (408) 777-3228 s"I=AX (40£3) 777-3333 • nuildin Icuertino.or ��
❑ NEW CONSTR"UCTI0N 0 ADDITION u ALTERATION / TI REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS T APN # a en I ry 1
OWNER NAME g jn � PHONE '[ V i ®� E-MAIL
STREET ADDRESS I CITY, STATE, ZIP t FAX
CONTACTME PHONE, e -E-MAH
_ c Q 2, _KC —
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STREET ADDRE S CIT .STATE, ZIP FAX
t, ry
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❑ OWNER 11 OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVEL PER TENANT
CONTRACTOR NAME TF LICENSE NUMBER R / fJ 6 LICENSE TYPEC_! ® BUS. LIC #
COMPANY NAME . j/ /� E-MAIL / so,rfl�l�t fDo o yl'y . FAX L C�
STREET ADDRESS !U CCITY; STATE, ZIP Y[`' /�V`/�L✓ ,
PHONE
ARCHITECT/ENGINEE NAME LICENSE NUMBER BUS. LIC E#
COMPANY NAME 6 E-MAIL FAX
sT x''11HONE
—%Z Sr%/AAe �f Cf-'Y's=Z'f , ox DDRESS (I P�ie� - 7 2 -Tl 3
DESCRIPTION OF WORK
e
EXISTING U E I PROPOSED USE CONSTR TYPE 1 # STORIES -
j - USE TYPE OCC. SQ.FT. VALUATION
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM - KITCHEN - OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: El DETACH -
ATTACH I}--
# DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES I
BF,INGADDED? ONO ADDITION? ❑NO
PRE -APPLICATION E] YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES RECEIVED $Y.C' T TALVAL ATION: -
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ' r
By my signature below, I certify to each of the following: I -am the property owner or authorized agent to act on the prope 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. !agree to comply with all ap licable local
ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the above -identified property for inspectio purposes.
Signature of Applicant/Agent: Date: —I -
SUPPLEMENTAL INFORMATION REQUIRED
New SED or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp 2011. doe 4vised 06/21/11