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B-2016-2187CITE OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR; PERMIT NO: B-2016-2187 10166 BONNY DR CUPERTINO, CA 95014-2904 (359 11.048) SENO CONSTRUCTION INC ANTIOCH, CA 94531 OWNER'S NAME: LEWIS MARILYN M TRUSTEE DATE ISSUED: 06/22/2016 OWNER'S PHONE: 408-761-9019 PHONE NO: (925) 584-1245 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO; License Class GENERAL BUILDING CONTRACTOR Lic. #896482 X BLDG Contractor SENO CONSTRUCTION INC Date 05/31/2017 _ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL T 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. JOB DESCRIPTION: REMODEL LIVING ROOM (375 S.F,); KITCHEN REMODEL (404 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 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 prfzormance of the work for which this permit is issued. //I have and will maintain Worker's Compensation Insurance, as provided for by the for this C/ �<Section.3700 of the Labor Code, for the performance of work which permit is issued. Sq. Ft Floor Area: Valuation: $36000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 35911 048 359 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 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 regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Sig' nature Date 6122/2016 Issued by: AbbyXende A Date: 06/22/2016 4 y OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: i. 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 ofApplicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 6/22/201 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 DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices 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, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Omer or authorized agent: APPLICANT CERTIFICATION `Date:26/2 /2016 CONSTRUCTION LENDING AGENCY there I certify that I have read this application and state that the above information is I hereby affirm that there is construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws r i of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender' Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 6/22/2016 professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 77723228 • FAX Ci. PERTINO ! I ((408) 777-3333 • building(ftupertino.orat)—�y � I1 -t f, NESV CONSTRUCTION ❑ADDITION ALTERATION / 1'I ! REVISION / DEFERRED ORIGINAL PERMIT# / PROJECT ADDRESS J �-66 BEING ADDED?' ❑ NO APN# iJ✓ _IU OWNER OWNER NAME PHONE O l E-MAIL LJ042U STREET ADDRESS CITY, STATE, ZIP C. G P e (2 `(` Y d FAX got K,G Q vVyl 0 CONTACT NAME / PHONE E-MAIL STREET ADDRESS STATE, ZIP C_ V P e to -r 6 CITY, (r% ( V. a FAX E3 OWNER E3OWNER-BUILDER❑ OWNERAGENT PQ CONTRACTOR ❑ CONTRACTOR AGENT ElARCHITECT El ENGINEER El DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUM LICENSE TYPE BUS. LIC # AL COMPANY NAME J E-MAIL y �y Sem, COv1 TB -0n Se,.� Scft et% gyp,► FAX —qZr- ?1P 2XV1 STREET ADDRESS r ^ CITY STATE, 7�IP PHONE /�!\ or S' rI h IuTIe7 _ C_A a C, S-3 / q7 r^oU[ o ARCHITECT/ENGINEERNAME I LIC NSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE; ZIP PHONE DESCRIPTION OF WORK P2q-A9;X-A-773 'ninmetn®cv,-I; C-13 USE USE I TYPE I OCC. I SQ.FT. I VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODELAREA REMODELAREA REMODELAREA F u W hLLllvti U II S: ISA SECOND UNIT El YES SECOND STORY ❑ YES BEING ADDED?' ❑ NO ADDITION? [:]NO PRE -APPLICATION ❑ YES IF YES,. PROVIDE COPY OF -- PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? []NO EIVEDA •T F , , d TAL VALUATION: y 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 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ,�� Date: SUPPLEMENTAL INFORMATION REQUIRED.c TYPE'­ <., . » ,. '� % Roup INc SLIP� �OSERTHECOUNTER © BUILDING PLANREXIIFY _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building.'❑ EXPRESS REiEW FLONING PLAN114 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1� sTANDATib ` " ❑ PiisLlt wfllucs form if any Hazardous Materials are being used aspart of this project. ❑ LARGE ❑ _ Copy of Planning Approval Letter or Meeting with Planning prior to ; ❑. ': TIRE DEPT ❑ SANTT1iYS submittal of Building Permit application. MAJOR WER,DI5IRICT BIdgApp_2011.doc revised 06/21/11