The URL can be used to link to this page

B-2016-2507CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2507 19479 ROSEMARIE PL APT 3 CUPERTINO, CA 95014-3452 (375 01 007) OWNER -BUILDER 19479 ROSEMARIE PL CUPERTINO CA 95014-3452 OWNER'S NAME: COHEN DAVIDN ET AL OWNER'S PHONE: (650)776-9160 LJCENSED CONIRACTOR'S CONTRACTOR'SDECLARATION License Class Lic. # Contractor OWNER -BUILDER Date hereby affirm that I am licensed under the provisions of Chapter 9 (commencing lith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: r. 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. 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: $2000.00 APPLICANT CERTIFICATION DATE ISSUED: 08/15/2016 NO: None BUILDING PERMIT INFO: BLDG X ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: UPGRADE SUB PANEL (100 AMP);SAME LOCATION (UNIT 3) 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 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9,18. Signature Date 08/15/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: s. 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. %z. 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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption; I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 may accrue against said City in consequence of the gra g of this permit. Additionally, the applicant understands and will comply with on -point source regulations per the Cupertino Municipal Code, Section 9.18 f Date 08/15/2016 APN Number: Occupancy Type: 375 01 007 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date: 08/15/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cuperti unicipal Code, Chapter 9.12 and the Health & Safety Code, S s 25505, 25533, and 25534. ,Owner or authorized agent: Date: 08/15/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO GENERAL PERNUT APPLICATION COMMUNITY DEVELOPIdiENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinana cuoerino.ord IPLU1,1BNIG n\!ECH!,\TIC'AT. T FrTRTr AT MIS 17-2-016 s Z.S'o )—It.�Tcrrr T A J=nt PROJECT ADDRESS s4!"P/ mar�e. OWNERNAME K' PHONE �S/J� �^ E-]/iA1Z C'ok,,--v,- Cn ��MAI !' i /�/ STP,EET:JDP.ESS t O � • u I CITY, STATE, ZIP I DX(r� ! G►51( c� � A �� CO\TACT NAI E PHr/ T 2 f O\ C7g 2 " ') AQ) 1 eSs s( STREET.4DDPESSr<%CITY, r1 STATE,?PG� �I` Q� C�^C �0� FAX ❑ OFTN ❑ 0VW7.-t-BUTIMER IJ OS+ t.AGE?\T ❑ CC TRACTOR 13C01\7RACTORAGE\'T ❑ fiRC3TCT ❑ Gi R ED ❑ TD,�ANT CO \T R 4CTOR ; Ahal LICENSE I\'UT,SER / 2 g I LICENSE T1TEi� BUS. LIC T COh4P.A\Y NAMEp n r oxe L(' 4+1 n' E-'% � 2 . EhAIL ��!LL1�t STREET:ADDPESS CITY, STATE, ZIP �``T 4 _ s►1 Carins. PHo, E 6 5 CPS -�LSb .kRCHJTECT:'NGNEER N AAiE LICENSE NUMBER BUS. L1C COMP.-".IYN.A.IuE F_ viAIL FAQ _ STREET.ADDRESS ( CITY, STATE, ZIP I PHONE USE OF ❑ S -FD .,DUPLA ❑. IvULTI-FAMILY PROTECT D\ WILDLA\-D ❑ 1 _s PROJECT W El ).-Es IS THE BLDG .AN ❑ YES BUILDNG: ❑ COh =- CIAL 'URBAN A7EPFACE AREA ❑ .No FLOOD ZO\'E I EICHLEP HOME? ❑ I: -O DESCRIPTIONOF WORK 5 ('li 'I'D 0 h all r `&\fir E.i Ce TOTAL VALUATION: \11 ing: I am the prop : j' owner or authorized agent to act on the property owner's behalf I have read -1us B v m\ signature below, I cenij' to each of�de�s application and the inroanation I have arovcoT ect. I hae read the Descrption of �T o k and v ,zfi' itis Accu ate. I ag ee to comply with all applicable local ordinances and state lac s elating to buildLcons a'on. I authorize representatives of Ci -,p --,--,mo ino to rater the above-ide tilled . rope ty for inspection purposes. Cignpture of :pplicant!.yeent: bate: '. SL IPLTMFNTT_ t7ORM TION REQUIRED ❑ {ji ER TFC-COU\TER ` ; SIAT\33"FD �.L RGE ❑ .. AA AJOR _>,�EPA%isc,4�p_?011.doc revised 06.i17/II in Dear Property O"r(0);' Atj:pppjjj forac i a J your n,3 —4 Mjn9'.YPum0 ff a. Old Wilda of, theproperty Ro"Olade Ph -CuOrtino, CA informatIM m4ke yam. ire 3rer-stilloet W f.1�•s�3��'S.�sar��`aI'zat'��F�#��fi.r�,��, ,*��*a:��i�F1�=� for issuing agent WPjej7 the permit Date; retied vmun