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B-2016-1306CITY OF CUPERTINO BUILDING PERMIT SU"ING"DRESS: CONTRACTOR: PERMIT NO: B-2016-1306 10625 MORENGO DR CUPERTINO, CA 95014-3513 (375 34 009) COAST TO COAST DEVELOPMENT INC SAN CARLOS, CA 94070 OWNER'S NAME: ROBINSON CHRISTOPHER S AND MARY -ANNE E M TR ISSUED: 08/26/2016 OWNER'S PHONE: 408-341-5109 I PHONE NO: (650) 654-6412 MWDICIC] DJ)XIKOI�v NfA�Tft to] 14,12 1) Raj OKI 117414 0 License Class B Lic. #0746563 Contractor COAST TO COAST DEVELOPMENT INC Date 03/31/2018 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I 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 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. 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. r � � Signature (fir%'✓l'vl IJ'A,fQi, Date 08/26/2016 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) 2. I, 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: 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. 3. 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 t0 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 08/26/2016 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X' RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FRONT ADDITION (450 S.F.); CREATE (N) 2 CAR GARAGE (424 S.F.); BATHROOM REMODEL (70 S.F.) Sq. Ft Floor Area: 874 1 Valuation: $150000.00 APN Number: Occupancy Type: 375 34 009 Deferred Submittal (R -3),R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST Issued by: ON. 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 ofAppl Date: 08/26/2016 "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 dermed by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Cade, Sections 25505, 25533, and 25534. J; Owner or authorized agent Ll /, ? A"-&, -&, . Date: 08/26/2016 a 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION. 10300 TORRE AVENUE CUPERTINO, CA 95014.3255 (408) 777-3228 • FAX (408) 777-3333 - build] ngfloupertino.org El NEW CONSTRUCTION CG -"ADDITION 7 ALTERATION / Ti 7 R P.VIgrn,,I / T)PV uRFn nutrnaaT- VPP KA T it PROTECT ADDRE S S d &LtV APN # � � o OWNERNAME * �/wr '7v� 1Z 20 ,�5flry PHONH 4o 3 ! 3/og &MAIL STREET ADDRESS10 r Z5 y� �D n AJ CITY, S1ATE,�ZIP��u� -hyo JE FAX CONTACT NAME �yP4 Irt.A -PDO [Z—QV Awtiewk PHONE -MAIL e tdt] +Nh 1. KLA >F4iZ c STREET ADDRESS +) ` YA ,T � . o- 6, STATE, ZIP� � 1 FAX IT'ENA�N�T 0 OWNER ❑ OwNER-HUtLDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ARCHITECT 111 ENGINEER © DEvELOPBR ❑ CONTRACTORNAME 1 /r3s LICENSE NUMBERO 1 i�6) /• i i (� LICENSE TY1 BUS. LIC # g Z L COMPANY NAME. E-MAIL FAX STREETADDRESS CITY, STATE, ZIP PHONE ARCHITFCT/ENGINEERNAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS Crf-Y, STATE, ZIP PRONE DESCRIPTION OF WORK L Ay1 XL— _%iV l 1 'iVC V 2GI. i�L Gt E ) ! O e -t- q= i�� i �'C7�F.y�t ��f'f1}• EXISTING USE.. .. PROPOSED USE CONSTR.TYPE #STORIES USE 'TYPE OCC. SQ.FT. VALUATION (S} EXISTO AREA } '? /!- {X NEWFLOOR ANSA L; S• DEMO AREA TOTAL .NET AREA / O EATHROOM_. KITCHEN REMODELAREA "�� REMODEL AREA -C> OTHER REMODELAREA PORCH AREA-0DECK AREA TOTAL DECK/PORCH AREA GARAGE. AREA:DETACH [RATtACH #DWELLING UNITS: 15 A SECOND UNITFS BEING ADDED? f SECOND STORY YESI ADDITION? roO - QNO PRE-APPLiCAT10N []YES IFYEs,PROvroECOPYor PLAN`KfNQ ADPL# [jJ.W PLANNING APPRO\ AL.LETIER ISTHEELDGAN OYESTOTAL EICHLER ROME? UrNO VALUATION: G"tRi 00 By my signature below, I certify to each of the following: I am the property owner or autliorized agent to act on the property owner`s behalf. I leave read this application aad the'infounation I have provided is correct I clave the Description of Work and Verify it is accurate. I agree to comply with aU applicable local ordinances and state laws relating to building cons ction _thorize representatives of Cupertino to enter the above -identified for inspection purposes. /property Signature of ApplicantlAgent: Date: SUPPLEMENTAL rNFORMATION REQUIRED gvl;R xER soil Dli�c Pz �1. REv1Et�+ New SFD or Multifamily dwellings: Apply for demolition permit for issuance building existing building(s). Demolition permit is required. prior to of :, it permit for new budin g. iD .EXPRE Commercial Bldgs: Provide a completed Hazardous Materials Disclosu - STAT UARD __—_ Piil£i t �x oxr s form if any Hazardous Materials are being used as part of this project._;_ Copy of Planning Approval Letter or Meeting with Planning prior to r_I-_LAIiGL - —_ subnuttalofBuildln application. 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