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B-2016-2454CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2454 10088 N WOLFE RD CUPERTINO, CA 95014 (316 20 108) CEVOLA CUSTOM HOMES 832 CHYNOWETH ST, SAN JOSE, CA 95136 OWNER'S NAME: Cupertino Property Devel I LLC DATE ISSUED: 08/08/2016 OWNER'S PHONE: 408-343-1058 PHONE NO: (714)931-2995 LICENSED CONIRACTOR'S CONTRACTOR'SDECLARATION BUILDING PERMIT INFO: License Class CABINET MILLWORK AND FINISH CARPENTRY Lic. #923493 Contractor CEVOLA CUSTOM HOMES Date 10/31/2016 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: STE 120 DOPPIO ZERO - (1) EXTERIOR TRELLIS STRUCTURE FOR PATIO (459 S.F.) 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. u2/"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 ermit is issued. Sq. Ft Floor Area: Valuation: $15000.00 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 and state laws relating to building construction, and hereby authorize 316 20 108 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 this permit. may accrue against said City in consequence of the granting. all Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 8/8/2016 Issued by: Abby A e�nde Date: 08/08/2016 OWNER -BUILDER 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 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. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/812016 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 z. 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, 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 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 devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of 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 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. Owner or authorized agent: APPLICANT CERTIFICATION C to: 8/8/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION 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 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'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date/8 8/2016 Licensed Professional CONSTRUCTION PERMIT APPUCATIONc��-- 00MMllN17Y DEVELOPMENT DEPARTMENT w BUILDING DIVISION 1OW TORRE AVFNUE • CUPERTINO, CA 95014.3255 CL)PI~MINCi (408) 777-322,8 • FAX (4/08) 777-3333 w bu11diinnra@cunertinv ong rMWVA'%mwiwr r ffnw nannrrrrrs - .YI AST terrnwr r�rs a l na:emn�,,.� rr,�rr,�.a,�-n //J�y�+^� _ #�/�� 1PRQIECCNiDiiESSAM# _-----'- !{yam/'] __�...._.��...,..,...:r lob [Q GG��j�• �'+� j� jam) C'��+ Sl rADDRES5 + f'g2 ii�iM1 �+ ' �` � C 1 warp i .4�ai+� AX/� F �i�] %45-iv61 GOI3TACrNAML d�i'� �i ..1 £Ii0m4ir% �JNc.� 50 ,0411 _ 2&hlAii � CJIYI� S1RMADDRESS Kgn&iN vt9pv 14+1 FA$ 6ejo1wA5-3 is owm 0 {3wmm-mDif.m 13ownExAG'Lm v O Cl1 rams ag EJ cm crnxFAC(�Ft 13 amm cr ©ma*3na g. 13DwraomR 'PBNAw �cmR2dAt�76 ..7-OEy-^� [,7.✓.' ii31[1� ��1"1� 7E'fY4E $[TSLIC COMPAWMAME Cavo o LIV EMAIL FAX Z37iREEYADDRL+SS 4 p +r_ vrn+�/��% ��(j 1r / -�i.*2�.�yL� W 7j��f $ .ItG#.Apys -f1 GYiMi'AI1$T3AMLr ` Ilf ` �^F T ! '' " i " 1 'Aar::�P✓Wri(/ ja SAX MMAMMS Q'1 40'u A *4. C1iY,STAY$7.p' 015.646 { 24 iflSSMMU E �.. Y PROPDSEITIIS@ CONMR.TYB$ 1. i 3 175& ME OM SQ FF VAAWA'LfON M ARIA%_ ARIA 'ARIA - ivaiARFA y , ��':�}� _ a' s 451 is, BAiT18QC1M uWaDMAM& Kli7[9Q+pi - It13MIMARFA 01iDR - - RIMOOMARIM , 1100 tTARFA 1 DIEMAMA TOMLDUCKWOWHARE& G MAGRARE&- E3lilyl'ACn. QAIrAQL 01)VE SRiGDt M - ISAW&30 i;IIHW ❑VW UMMAINUM 13M -9MO DSMY vris - AUMTXM4- ONO - - P99,kVrACA'nCna HM 1 YE,%n VMHCapYOF W-AMMAMN 00 NA1aCRt7fiAMOVALLMM 319MMM tsAN i{� MIt9lIa3RF OMM 13 NO BY, - _... , .... - �t � .. TOTAL VALUATION: #�` �,%^+"✓ I3YmYsisnamccbelow I xtifymeachofdR faliavr;ag XmntLepcepaiyowneroaauth agcnttaacEonihcpmnp�iyawua'siseT�aif iLavcr ti this appiication andihobTe>mafimll avepmvidedisco rmt Ihaveread the Desc6p6-4Gf S aC=MLD. Ia5=LQ cnmylY viffi aliapplieabM focal onimanoes snd sEate laws ictaimg #a bw7clmg tccs� ot5" igFie tatives ofCOpmfino to entw ffictgeEahr forimwCff-purposes. SiLamofApplicauffAg / r"` late; 6/ SUPPLAN"FAl. DWORtvEii110N PXQUMM N wSFD or Multtf=ffy dwdiffi s: AWY for deo 6Hfi- peomit far existingbufi iDgfs}_ Dmttlihonpern*isseTHMdpnorto ssoanoeilfbluilding pDtTnitforaewbuilcpng. CommerdalBldgs: Pravi&acnmpletedffazazdumlM erialslYisolasuM £o 6if project—/ CopyofPiamftAppmvdLeffmarMwtmgvi&PLunftpnorto sublDitfal aFSuildingPermit applicati�. 13 IYy FTH&CtiDNIS� ❑aa.armenr� T BARD Ct r.AsMa_ i - - r' ' z�evlatiy El punuewolm U�3' n p� y ❑ sArurAlo�sz�senlsralcr � $NVJBtOPm3lgdT•AT:�At,TiT .Stipp 2U1Ldw t m4sed 0&21111 -VCHIEVEMENT N INEERING Date: September 06,2016 Proiect NO: 2601 IMMIMN-MIFf"M-1 Oft of Cupertino, a ,}c16-��5� FRITi I W—H Stool Weldirtg ftlrw'� — Bosed on owner representative,s -request we visited the job site �on August19 and 30, 2046, a, ,observed the progress of new structural steel framiry weldingfor Gazebo by following ddtaiils: (6)2/4" Baseplate connecfecl' o (6) o6."using W'fiffletveld. (6) 6"x4" )( 1/4" HSS beams connected to (6) columns H86 4"x4"x 16" J n 5�/ -1 fillet weld all around, Base plate were connected to existing,concrete with all treadod,rod with Opogy. Certified welder was Kennoth Ricardo Mixicana. Material wasobserved brinspector. In general work was in compliance VOth approved plan sheet S7.1 detail I dated by 08?��l 6. Inspection was performed periodically and on call basis as requo$tedby the bwne.6� rep_resentative-' _ s - 4 �-- s• no Q- i -4 *Y74 -My ffixi, S Z'T or findings. We do not undertake the goarantee of construction nor do we reli ieVe the tontrador of his primary responsibility to produce, a completed projeO in accardanm with plans specifications. ffir. If you have any questions or need any additional information, please feel freetb call us at your convenience. mmsm� Sina Hooshdar, P.E- State of California Licensed Civil Engineer Address: 2455 Autumnvale Drive, Unit E, San Jose, CA 95131 - Tei: (408)217-9174,,,Fax: (408)217-9632 www.achieveng,com Form R-11