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B-2016-2063CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2063 10240 DUBON AVE CUPERTINO, CA 95014-2610 (342 14 049) STRUCTURES OF INTEGRITY SAN JOSE, CA 95136 OWNER'S NAME: GEIGER JANET E OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. #732878 Contractor STRUCTURES OF INTEGRITY Date 01/31/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing pith 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: 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. 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. 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 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,. th ppl' ant un rs f s nd will comply with all non -point source regul io s ,e p i o icipal Code, Section 9.18. - i Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business& Professions Code). DATE ISSUED: 08/26/2016 PHONE NO: (408) 628-7147 BUILDING PERMIT INFO: BLDG —ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: IODEL KITCHEN (456 SQ FT) AND FAMILY ROOM (431 SQ FT). 1- NEW SUB PANEL (100 AMP) UTILITY RM; RELOCATE MACE UTILITY RM; RELOCATED WATER HEATER UTILITY RELOCATE SEWER PIPE FROM INTERIOR TO EXTERIOR ,L KITCHEN. Sq. Ft Floor Area: I Valuation: $130000.00. "N Number: Occupancy Type: 342 14 049 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: MELISSA NAMES Date: 08/26/2016 RE -ROOFS: All roofs shall be inspected prior to any roofmg material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 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. 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 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 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 B Air na ement District I will maintain compliance with the u e o c' f ' od , Chapter 9.12 and the Health & Safety Co e, a t1' s, 3 and ZSa 4. Owner or authorized agent: Date: 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 1 understand my plans shall be used as public records. Licensed GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION MEP 1-10-4 10300 TORP.E AVENUE r CUPERTINO, CA 95014-3255 — MISC %% cuPEATtNo (408) 777-3228 • FAX (408) 777-3333 building aeonerfind.org01 b �o(� I- IPLIUMMING I r� IMECHr� AM( -AT. I IF7T:rTRTr`-T i71.,rrc�rrr A, - In ----- '- - LJI'11JL LLLA:I\LV UJ PROJECT ADDRESS/1I APN 0 S7 OG\tiERN,AhE`- oc"aT�+G- t E -h` � 1 cTREET ADDPESS C ^ _ �o� �x..�.,.. CITY, STATE. ZI �,�� .^i ri"L � � r C..� I I �ci � �v'� 1. FAX Co?-rArr NQ,,E GQ rZCS �rLi1� Pxol. .TLgIl O� 6 20-2f STREET.ADDRESSZ4(f IF-tczl CITY; STATE, ZIP n i A FAX ❑ OWN -IM O O"AINER-BUILDER ❑ MWERAGENT ❑ CO\TRSCTOR ❑ COATRACTORAGENT ❑ ARCHITECT ❑ iTGNZ �R ❑ DEV'r.LOPER ❑ TETA2,:T CON-IRACTOP.NADT LICEh_�F,I� BE I LIC�SE TYPE `` ((E-iJiAIL I BU S. LIC N COMPANY NAME ,,r�te` �� r �'-t Cep L� STREET ADDRESSCITY, STATE. ZIP 0' Ls PHO-' p _ C2 A-,RCHITECT,'E' GLNEER,'=.A;E A LICENSE NUMBER BUS. LIC- COMPA?YYNA?iE 4�•y� E?i4IL Fkx STREET ADDRESS I CITY, STATE, ZIP PHONE USE OF ❑ sFD OrDUPLEX ❑ I ,=i-FA:ILY PROJECT IN ll•'II-DLA'`TD ❑ 1 s PROJECTNI ❑ }''ES IS THE BLDG AN ❑ YES B= 1G: ❑COWBIERCIAL LP.BAN.IN'TERFACEAREA ❑ NO FLOOD ZONE ❑ NO I EICHLERHOME? ❑ I: -O DESCRIPTION 01 WORK. ' � .Loo- A--PA-m-P P14z "Si,.-- c),R - 2 c , AwW w -I 0 .PA-t�" TOTAL VALUATION: RECEII FD BY By my si_nature below, I certify to each of the following: I a:n 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 veri j it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildinz construction. I authorize representatives of Cupe Liao to enter the above -identified property for inspection purposes. Signature ofApplicanty.,eent: Date: SUPPLEIMENTAL TINTORMATION REQUIRED �` t F1 LSE -ONLY rl �✓�i ��v�" y� � �j ��y,�/� ` z ❑ fl� ER THE-COU\T.E 1 �..y�� EaPRESS� J � Es rlr.AZ4JOR _>iEPA%isc:4pp_?011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2063 10240 DUBON AVE CUPERTINO, CA 95014-2610 (342 14 049) STRUCTURES OF INTEGRITY SAN JOSE, CA 95136 OWNER'S NAME: GEIGER JANET E DATE ISSUED: 08/26/2016 OWNER'S PHONE: 408-505-1101 PHONE NO: (408) 628-7147 LICENSED CONTRACTOR!S CONTRACTOR!D 4rA_R TION BUILDING PERMIT INFO: License Class B Lic. #732878 Contractor STRUCTURES OF INTEGRITY Date -01/31/2018 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: REMODEL KITCHEN (456 SQ FT) AND FAMILY ROOM (431 SQ FT). I hereby affirm under penalty of perjury one of the followingtwo 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 performance of they work for which this permit is issued. 2. ' % 1 have and will maintain Worker's Compensation Insurance, as provided for by kSection 3700 of the Labor Code, for the performance of the work for which this permit is issued. " Sq. Ft Floor Area; Valuation: $130000.00 APPLICANT CERTIFICATION 1 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 342 14 049 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 sai , City in consequence of the granting of this permit. Additionally, the afa'pli r' o- 0 rstands d will comply with all non -point WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR source regulations e i D npal Code, Section 9.18. 180 DAYS FR C ION. Signature Dat 08/26/2016 Issued by: MELISSANAM OWNER -BUILDER DECLARATION Date: 08/26/2016 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 2. 1, 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: 08/26/2016 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 2. 1 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. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. 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 Worker's Compensation laws of California. If, after masking this certificate of material. Additionally, should i use equi meat or devices which emit hazardous air contaminants ass ddefined by the Ba Are 6a ement District I will maintain compliance with the C pe,,, i C d C pter 9.12 and exemption, I become subject -to the Worker's Compensation provisions of the the Health & Safety Code, S iio S 5 5 . n 5534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked Owner or authorized agent: APPLICANT CERTIFICATION Date: 08/26/2016 I certify that I have read this application and state that the above information is CONSTRU ION LENDING AGENCY correct. t 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 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 08/26/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 E(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.ora ` -loU f a _ j®� 0 NEW CONSTRUCTION ❑ ADDPITON ALTERATION /'TI REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN #% i -0461 OWNERNAME PHONE CV_6—C6- J STREET STREET ADDRESS CITY, STATE, ZIP FAX A . S A` p CONTACT NAME ` CrF PHONE 00 A- EMAIL j / p & s STREET ADDRESS, J2/C , - ,> r CITY STATE, Z� FAX t A ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT LTJ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER" ,3Z. 7 b7 LICENSSE_TYPE BUS. LIC # COMPANY AME E MAIIS G -)G �� s FAX MIA STREET ADDRESS jj ��'r j j 43 CITY, STATE, ZIP 97,5113(a PHONE ARCHITECUENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL SSSF1`G�.r � Lq FAX��r�ry� �yryON STREET ADDRESS _ 6 CITY STATE, ZIP 15 `0V � �^'� �y �P j -g y y P e�- 9 IO — [ Z ® s DESCRIPTION OF WORK p 4 ` 4ILS M ' mat j,�l lie fo � � a�l�+a-'l`•c� •'�p� '��7�� ,�ry-s-g ,, !%7 EXISTING USE - PROPOSED USE - CONSTRTYPE - #STORIES - -- T - USE. TYPE OCC. SQ.FT: VALUATION ($) EXISTG NEW FLOOR DEMO _. TOTAL - - AREA AREA AREA - NETAREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER. REMODEL AREA PORCH AREA DECK AREA . TOTALDECK/PORCHAREA GARAGE AREA: 13DETACH - ❑ATTACH I # DWELLING UNITS: ISASECOND UNIT [3 YES SECONDSTORY ❑YES - - BEINGADDED? ONO ADDITION? ONO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER ROME? ❑ NO�D j., y' `` AL VALUATION: n s�-y"'y Y to eac t o the property owner or authorized agent to act on the proerty owner's behalf_ I have read this By my signature below, I certifyp application and the information I hav c ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to u' < c representatives of Cupertino to enter the above-idenoed p petty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED p 3' _ New SFD or Multifamily dwellings: Apply for demolition permit for Y existing building(s). Demolition permit is required prior to issuance of building permit for new building. r Bldgs: Provide a completed Hazardous Materials Disclosure atsitrs _Commercial form if any Hazardous Materials are being used as part of this project. 3- - _ Copy of Planning Approval Letter or Meeting with Planning prior toI submittal of Building Permit application. �isTtt Q