Loading...
B-2016-2558 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2558 868 S STELLING RD CUPERTINO,CA 95014-4270(359 22 009) M G CONSTRUCTORS &ENGINEERS INC MORGAN HILL,CA 95037 OWNER'SNAME: CLARK DAVID TRUSTEE DATE ISSUED:08/22/2016 OWNER'S PHONE:916-234-3346 PHONE NO:(408)842-5599 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#642058 Contractor M G CONSTRUCTORS&ENGINEERS INC Date 07/31/2017 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: VERTICAL FOUNDATION CRACKING REPAIR;REPAIR I hereby affirm under penalty of perjury one of the following two declarations: HORIZONTAL FOUNDATION CRACKING;REPAIR GIRDER END 1. I have and will maintain a certificate of consent to self-insure for Worker's SUPPORT;INSTALL SEISMIC HARDWARE IN GARAGE 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, Sq.Ft Floor Area: Valuation:$8600.00 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 359 22 009 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 said City in con a ce of the granting of this permit. WITHIN 180'DAYS OF PERMIT ISSUANCE OR Additionally,the ap leant under ands an will comply with all non-point source regulations the C e ino Mu icipal Code,:Date etion 9.18. 180 DAYS FROM LAST CALLED INSPECTION. /j . Signature , 8/22/2016 Issued by:Abby A e� nde / Date:08/22/2016 OWNER-BUILD EC ARAGON I hereby affirm that I am e e pt from the Contractor's License Law for one of the REROOFS: 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(See.7044,Business&Professions Code). Date:8/22/2016 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. 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 c mit hazardous air contaminants as defined by the Bay Area Quali Manage ent District Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertin unici al Code,C apter 9.1 nd exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Secti 5505, 5533 fid 5534 Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:8/22/2016 I certify that 1 have read this application and state that the above information is CONS CTIQUEL GIA E correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constr ction ending agep y or the erformance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issu d(Se .3097, ry 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 8/22/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE.CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333®buildingflcupertino.org NEW CONSTRUCTION I ADDITION ALTERATION Tl Q REVISION/DEFERRED ORIGINAL PERMIT# PROJEy $ESS 3 1 1 APN# 'b`d @-n CN l❑!' ' 7 Y OWNERNPHONE �`��" +� E-MAIL Aesf STREET DRES ✓'b V ?-04 CITY, A'CE,..ZIl' �1 FAX L.CONTACT NAME • PAONE �"" i E STREET ADDRESS v � " CITY,STATE,ZIP ^�..�j F 0 OWNER 0 OwNER-BUILDER 0 owNERAGENT E&CONTRACTOR CONTRACTOR AGENT D ARCHITECT 0 ENGINEER O DEVELOPER ❑TENANT CONTRACTOR NAME LICENS ER LICENS BUS_LIC# �'ts � OS SC COMP NAME STREET ADDRESS �' " ,STATE,ZIP PHONEZ_ r*46 fyW-t1 .,*1Wyd 3' '. �CITyov' t/l C,4 X51037 ARCHITECT G ERNA16 LICENSENUMBER BUS-LIC 4 Caw NANIT e,�uC(c�r�S'e- Yt L ✓' �L �tL �t9K a� Yom- ,/S s C.,{ STREET ADDRESS 0 r r► CITY,STATE,ZIP PHONE Vint •ter ✓ .?J-- c tai DESCRIPTION OF WORK f/t>Ev>Z EXISTING USE PROPOSED USE CONSTR TYPE. #STORIES ' USE TYPE OCC. S¢.FT_ -VALUATION($) EXISTG NEW FLOOR DEMO TOTAL - - - AREA AREA AREA NEI AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCHAREA DECKAREA TOTAL DECKTORCH AREA I GARAGEAREA: ODETACH - - - ©ATTACH #DWEITINGUNITS: ISASECONDUNrr OYES SECONDSTORY DYES BEINGADDED? (ANO ' ADDITION? ONO PRE-APPLICATION DYES ]EYES,PROVIDE COPYOF ISTHEBLDGAN DYES B TO AL VALUATION: PLANNINGAPPL# :ONO PLANNINGAPPROVAL ETTER EICHLERHOME? 0N 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 application and the information I have pro ed is co I. have read the Description of Work and verify it is accurate_I agree to comply with all applicable local ordinances and state laws relating to build' ction I authorize repres ves of Cupertino to enter the above-identified property for inspection purposes. Signature of Appiicant/Agent. Date.NA a/rte SUPPLEMENTAL KFORMA Q D FLANCHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING PLANBEVIEWIV existing buildings)_ Demolition permit is required prior to issuance of Building permit for new building. 11 EXPRESS ❑ PLANNING PLANREVIEW M _Commercial Bldgs_ Provide a completed hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0 LARGE ❑ FUZEDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR II SANITARY SEW>iR DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BIdgApp 2011_doc revised 06121111