Loading...
B-2016-2481 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2481 6595 CLIFFORD DR CUPERTINO,CA 95014-4555(369 26 006) GAGNE BROTHERS ENTERPRISES INC NOVATO,CA 94949 OWNER'S NAME: FRANCIS RICHARD N TRUSTEE&ET AL DATE ISSUED:08/09/2016 OWNER'S PHONE:408-805 6889 PHONE NO:(415)506-0400 LICENSED CONTR ACTOR'S DE LAR ATION BUILDING PERMIT INFO: License Class CC-36 Lic.#857357 Contractor GAGNE BROTHERS ENTERPRISES INC Date 04/30/2017 X BLDG —ELECT X 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: REPLACE WATER MAIN SERVICE I hereby affirm under penalty of perjury one of the following two declarations: REVISION#1-(N)PROPERTY LINE CLEANOUT;(N)FOUNDATION 1. I have and will maintain a certificate of consent to self-insure for Worker's. CLEANOUT;REPLACE SEWER MAIN(1001)-ISSUED.8/18/2016 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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:$7200.00 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 369 26 006 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 s sai ity in consequence of the granting of this permit. Additio y,the appli • t understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR sour regulatio er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur Date 08/18/2016 Issued by;PAUL O'SULLIVAN Date:08/09/2016 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 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 ofthe property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/18/2016 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 MATERIALS DISCLOSURE 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 25505,25533,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 air contaminants as defined ea Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain complianc nth the Cuper o Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&S fety Code,-Se as 25505,25533,and 25$34. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:08/18/2016 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. Licensed Signature Date 08/18/2016 Professional GENERAL PERMIT APPLICATION Rev siogefill COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION MEF 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 CUPERTtNO (408)777-3228 • FAX(408)777-3333- buildina(Douaertino.org MISC PLUMMING ❑NiECHAIaIC.4L ❑ELECTRICAL ❑b6lSCELLA7\tEOUS PROJECT ADDRESS P 5p © APN �' C)NN ERNA7,1E �-- PHO E-MIAIL STREETADDRESS CI�'Y, S :TE.ZIP ��� F CONTACT\AME PHONE E 1 TAIL STREETADDRESS CITY;S ATE,ZIP I FAX lC� e�A C_A � ��-f tc� ❑ ov.N t ❑ Ott^ -BIJI DER ❑ OWINT RAGENT0 TR4CTOR ❑CO\Z'R.SCTOR?.GENT ❑ .ARCi�ITECT ❑DQGINE- ❑ DE\cLOPER ❑ TINA T CONNTR4CTOR NAh E LICENSE NUMBER I LIC SE%1 PE BUS,LIC fa 31 S�l [ FAX (OOL STREET. KESS p` I PHONE ARCHITECTIFN'GINEERN.-ME LICENSE NUUMER lBUS.L1C COMPANYNAI1fE E-A•L4IL I FAx STREET:S.DDRESS I CITY,STATE,ZIP PHONE USE OF ❑SFD orDUPLEX ❑ T,ULTI-FAMILY PROJECT LN A'ILDLA D ❑ 1 s PROJECTD\1 ❑YES IS THE BLDG AN ❑ ITS BLaDNIG`. ❑CON 4ERMAL UP.BA.NINTERFACEAREA ❑ NO FLOOD ZONE ❑NO I EICHLERHOME? ❑ ?,.O DESCRIPTION OFA%ORI s ev-W- Ri d S K IN ur ioke /(NI aK1&Kmj--arA- 1a a: TOTAL\ .LUATION: I t mx'-ED BI B y my sinna ure below,I c u to each of the follo��ing: la e property owner or authorized agent to act on the property owners behalf. I have read this app]ication and the infon ation I have provided is correTt. ave reg the Descrption of�T'ork and veli y it is acc te. I agme to comply with all applicable local ordinances and state laws elatina to building n. I au rize epresentatives of Cupertino to enter thea ov -�e�tifi d property for inspection purposes. Signature ofAtmlicant!4sent: Date: Ir SUPPLEMENTAL INFORI\4ATION REQUIRED oFiICE t ss.'oI.I ❑�>ERTBE-�OL'�TERu ti= 1 ;.-i."EhPRESS a J © ST3 33 RD _T c J _',SEP?i!sc,4y�_?011.doc revised 06.21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2481 6595 CLIFFORD DR CUPERTINO,CA 95014-4555(369 26 006) GAGNE BROTHERS ENTERPRISES INC NOVATO,CA 94949 OWNER'S NAME: FRANCIS RICHARD N TRUSTEE&ET AL DATE ISSUED:08/09/2016 OWNER'S PHONE:408-805-6889 PHONE NO:(415)506-0400 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC-36 Lic.#857357 Contractor rAGNE BROTHERS ENTERPRISES INCDate 04/30/2017 X_BLDG —ELECT X 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: I hereby affirm under penalty of perjury one of the following two declarations: REPLACE WATER MAIN SERVICE 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 U f Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7200.00 - 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 relati o building construction,and hereby authorize 369 26 006 representativ s this ci to enter upon the above mentioned property for inspectio urposes. (W )agree to save indemnify and keep harmless the City of pertino again liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may ccrue against sca City in consequence the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Ad Tonally,the app cant understands and willl comply with all non-point sorce regulatio er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. _Signa y Date 08/09/2016 Issued by:Kim Dunbar Date:08/09/2016 OWNER-B IUD 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 1. T,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(Sec7044,Business&Professions Code) 2. I,as owner of the property,am exclusively,contracting with licensed Signature ofApplicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/09/2016 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 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 25 ould I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,shoo use equipme t or devices w 'ehTemit hazardous air contaminants as def d by the Bay Are uiu-i"y Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compli ce with the Cuper' o M cipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Healt &Safe _ e,S ons 255 ,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. (Owner_"uthorized-ag APPLICANT CERTIFICATION Date:08%09/2016 _ i 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. Licensed Signature Date 08/09/2016 Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION MEP 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CtA PERTINO (408)777-3228• FAX(408)777-.3333 building(a_cupertino.org 's C PLUMBING ❑MECHANICAL [—]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESSAPN# r -� Gam`fF OWNER NAIviE PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP r FAX G 9 CT N n^^�) P$ONE ONTA n t 1� ` � EMAIL ST ET ADDRESS ,T FAX C� 94949 •off-/ L�OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT �Il CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICE SE TYPE BUS. LUI��fi �- �o COMPANY NAS. E_-MAI Ay i nv) U std Q✓l n i� vl f Le��"'1 STREET ADDRESS CITY,STATE,ZIPS PHONE \V C �4Z[�4 r74-7-?,?o( ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ) SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes .SLI IV o FLOOD ZONE El Yes DESCRIPTION OF WORK Y TOTAL VALUATION: RECEIVED BY .x yn.:<; By my signature bel I certify to each of the following: I the property owner or authorized agent to act on the property owner's behalf. l have read this application and the formation I have provided is e I have read the Description of Work and verify it is accurate. I agree comply with all applicable local ordinances and state aws rela a h g cons u iQn. I authorize representatives of Cupertino to enter the above-i ntified iroVerty for inspection purposes. Signature of Appiicant/Agen. Date: �$ SUPPLEMENTAL INFORMATION REQUIRED orcE USE a"ivL OVER THE COUNTE12 0 SIANDARD Z LARGE.. MEPMiscApp_2011.doc revised 03116111