B-2016-2511CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-25 11
19975 PEAR TREE CT CUPERTINO CA 95014-2318 (316 30 088)
SEARS HOME
IMPROVEMENT
PRODUCTS INC
LONGWOOD, FL 32752
OWNER'S NAME: GRANT TERRY L TRUSTEE
DATE ISSUED: 08/15/2016
OWNER'S PHONE: 408-257-3189
PHONE NO: (407) 551-6000.
LICENSED CONTRACTOR'S DECLARATION ATION
BUILDING PERMIT INFO:
License Class PAINTING AND DECORATING Lic. #721379
Contractor SEARS HOME IMPROVEMENT PRODUCTS INCDate 04/30/2018
X BLDG —ELECT _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:
ME
BATH REMODEL- M,P (40.5 SF)
,P
hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self-insure for Worker's
pensation, as provided for by Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued..
- 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: $40537.00
APPLICANT CERTIFICATION
I 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 30088
representatives of this cityto 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.
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.
Si Date 08/15/2016
Issued by: Kim Dunbar
2ION
Date: 08/15%2016
O ER-B ER
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 of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 08/15/2016
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
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. 1 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 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
/'j��
be deemed revoked.
.Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 08/15/2016
I certify that I have read this application and state that the above information isTI
N L A CY
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 retards. -
Signature Date 08/15/2016
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - huildina nrj ni jmzrfinn nm
%'Wrrittff
❑NEW CONSTRUCTioN El 1:1
❑ALTERAM0
ADDITION REVISION / DEFE
N / TI L PERMIT'
PROJECT ADDRESS
APN " :31
OWNERNAM13
-PHONE
E-MAIL
STREET ADDRESS7.
CITY, STATE ZIP
o 4
FAX
CONTACT NAME JEFF RAINEY
PHONE 510-427-4260
'E-MAIL jeffrey.rainey@aft.net
STREET ADDRESS
1069 EDGEMERE LANE
CITY, STATE, ZIP
'HAYWARD, CA 94545
FAX
510-783-1041
❑ OWNER ❑ OWNER -BUILDER 0 OWNERAGENT 11 CONTRACTOR OCONTRACTOR AGENT 0 ARCHITECT 11 ENGINEER 11 DEVELOPER 0 TENANT
CONTRACTOR NAME
Sears Home Improvement
LICENSE NUMBER
721379
LICENSE TYPE
B, C6,C20,C39,C10
Bus. LIC if
C?3
COMPANY NAME Sears Home Improvement
E-MAIL . temika@permitservices.com
FAX 866-629-8865
STREET ADDRESS 283 E Airway Blvd
CITY, STATE, ZIP Livermore, CA 94551
PHONE 925-245-2013
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC 4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK YA 16g. rf 2in-vicpr
,4-M? -akArzC &A-- c,,J-Th:7-. FAJ - X10P
EXISTTNGUSE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC,
SQ.FT.
VALUATION
EMSTG
NEWYLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOMKITCHEN
REMODEL AREA qO 1(2-
1 REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECKAREA
TOTAL DECK/PORCH AREA
GARAGEAREA:[] DETACH
rl ATTACH
#DWELLINGUNITS:
IS A SECOND UNIT E] YES
SECOND STORY E] YES
BEING ADDED? [-]NO
ADDITION? []NO
PRE -APPLICATION E] YES IF YES, PROVIDE COPY OF
PLANNING APPL 9 rl NO PLANNING APPROVAL LETTER
ISTHEBLDGAN E] YES
EICHLERHOME?
TPTAL VALUATION:
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to 5 7,
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
-oTTFork -d verify it is accurate. I agree to comply with all applicable local
application and the information I have provided is correct. I have read theDeS91"Aiaran
ordinances and state laws relating to building construction. I a presentatives of Cupertino to enter the above -identified properly for inspection purposes.
49/1-50
Signature of Applicant/Agent: Date: Z
9UPPtEMENTAL INFO TIO -REQUIRED
AB T
New SFD or Multifamily dwellings: Apply for demolition permit flor
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.]
`mss
IiiNtd
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
01
0W,
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.
8-
V
BldgApp___2011.doe revised 06121111