B-2016-2690-CANCELLED 09l 1,q
T- A-o c
as 8 cq-/ md/rw /c�e,
b ^ 20(C, - 2�qo� -rte mor
OC-
A1�,
�xc)paf�Al kne dear\ off .
�-J o W O tN O S CSG C-lC� OA- `��Q
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERW..T NO-B-2016-2690
22821 MEDINA LN CUPERTINO,CA 95014 2683(342 30.011) TRIPLE A.PLUMBING
SERVICES LET
STINKYDO IT CORP
SANTA CLARA,CA ;
95054
OWNER'S NAME: PONCE.RQBERTAAND SCOTT-PONCE LISA TRUSTEE
DATE ISSUED:09/0912016.
OWNER'S PRONE:408-996 2096
PHONE NO,( 855-$099 "
CENSER CONMACTOWS DECLARATION
BUILDING PERMIT INFO:
License Class Q-M Lic.#1943638
Contractor TRIPLE AP1 11 DING SERVICES i FT STINKY DO 11ORP pate. X BLDG _ELECT`X
Q7/3112 0 1 8 MECH X RESIDE _C RC
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 JOB DESCRIPTION:
license is in full force and effect, (N)PROPER'T'Y LINE C E OUT
I hereby,affirm under penalty of perjury one of the foilowing two declarations:
a. I have and will maintain a certificate of consent to self4usure'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:,'-3 have and will maintain Worker's Compensation Insur etas provided for by
Section 3 $A' R _
700 of the,Labor Code,for the performance the v}rk for which thus
permit is issued, Ft.Fl or Area: alpation:$3500.00
APPi IC NT RTIFI ATION
[certify that I Have read this application and state that the Bove N 1Vber: Occupancy Type:
information is correct.I agree to comply with all city and co my ordinance 3 30 011
and state laws relating to building construction,and hereb authorize
representatives of this city to enter upon the above mention d property for
inspection purposes. (We)agree to save indemnify and ke harmless th PERIVIIT EXPIRES WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and a enses which
may accrue against said City in consequence of the granting this perm . WITBIN 180 DA OF PE CE OR
Additionally;the applicant understands and.will comply with all on-point 180 DAYS ST CALLS CTION..
source.regulations per e-Cupertino Municipal Code,Section 9:
/ Issued by: SA
Signature% Date 09/09/2016 Date:0910912 16
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of theroofs shall be inspected prior to:any roofing material being installed.If a roof is
following two reasons: talled without first obtaining an inspection,I agree to remove all new materials for
a. I,as owner of the property,,or my employees with wages as their sole inspcction.
compensation,will do the work,and the structure is not intended or offere or
sale(Sec..7044,Business&Professions Code) Signature ofApplicant:
2. T,as owner of the properLy,am exclusively contracting
with flcense Date:09109/2016
contractors to construct the project(Sec.7044,Business&Profe . ons Code).
'
I`hereby affirm under penalty of perjury one of the following thre eciarations: ALL ROOF COVERINGS TO BECLASS"A"OR BETTER..
1. I have and will maintain a Certificate of Consent to self-, for Worker's
Compensation,as provided for by Section 3700 of bor Code,for the HAZARDOUS MATERIALS D1SClOSURE
performance of the work for which this permit is as�sued. I have read the hazardous materials requirements under Chapter 695 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505;25533,and 25534.I will
Scction 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I material.Additionallyt should I use equipment or devices which emit hazardous
shall not em to an arson in an manner so as to become sub'ect to the aw contaminants as defined by the Bay Area Air Quality Management District I
p Y _ p y.
Worker's'Compensation laws of California, If,,afterinaking this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 andthe Health&Safety Code ctio 25505,25533,and 25534..
exemption,I become subject to the Worker's Compensationprovi-sions of the
Labor Code,I:must forthwith comply with such provisions or this permit shall owner or authorised agent f' '
be deemed revoked. Date:09/09(2016
APPLICANT CERTIFICATION LENDING AGENCY
1certify that I have:read'this application and state that the above information is I hereby affirm that th;r onstrucbonlending agency for the performance
correct.I.agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097;Civ C.).
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree. Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs;.and expenses which may accrue e against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'SDECi, RATION.
and will comply with all non-point.source regulations per the Cupertino Municipal I understand"my plans.shall be used as public records..
Code,Section 9.18.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2690
22821 MEDINA IN CUPERTINO,CA 95014-2683(342 30 011) TRIPLE A PLUMBING
SERVICES LET
STINKY DO IT CORP
SANTA CLARA,CA
95054
OWNER'S NAME; PONCE ROBERT AAND SCOTT-PONCE LISA TRUSTEE DATE ISSUED:09/09/2016,
OWNER'S PHONE:408-996-2096 PHONE NO:(408)855-8099
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#943638
Contractor TRIPLE A PLUMBING SERVICES LFT STINKY DO IT CORP Date X BLDG —ELECT X PLUMB
07/31/201.a _MECH X RESIDENTIAL_COMMERCIAL
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 JOB DESCRIPTION:
license is in full force and effect. (I)PROPERTY LINE CLEANOUT
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.
2,-\'14C-1 have and will maintain Worker's Compensation Insurance as provided for b SANITARY
P , p y
Section 3700 of theLabor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$3500.00
permit is issued.
APPLICANT CERTIFICATION
I certify that l 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 342 30 011
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PE CE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS ST CALLE CTION.
source regulations per a Cupertino Municipal Code,Section 9.18.
Issued by:NIBLI AN)
Signature Date 09/09/2016 Date:09/09/2016
- RF ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the AU roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:09/09/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(x)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California.. If,after making this certificate of the Health&Safety Cod!77-25505,25533,and 25534.
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
Owner or authorized agent
be deemed revoked. Date:09/09/2016
APPLICANT CERTIFICATION ONLENDINGAGENCY
I certify that I have read this application and state that the above information is I hereby affirm that th r onstruction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
'GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION MEP
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERT(NO (408)777-3228 • FAX(408)777-3333•building5cuoertino.ord MISC
'1-u 14— Z-6 0
(LUNBING ❑1,ECIiANIC.AL ❑ELECTRICAL ❑MISCELLANEOUS
PROTECT ADDRESS Y- I APN T
O' NER NAhfE I PHONE E-T/ifiII
STREET ADDRESS ITY, STATE,ZIP FAX
CONTACT N.4MM �\
01V
VC PHO V E-A�iAIL
ST E ES 4 l �® CITY,STA E,ZIPcknlya ��. I F
Ow"TR ❑ Oti;.Et-BL'ER ❑OVN-FRAGENT D COI`TR4CTOR IJCO-I RACTORAGDNT ❑ P,RcHJTEcT ❑TG,-,,EE-R, ❑ DE1cLOPER ❑ TEI-�.i:T
CONTRACTORNAh LICENM -R LICiR�SET= BUS.1IC11
zq f .
COh4PANY N"' E-MAIL FAX
r
STREET ADD Lam
�T /y l- CPY V
ARCHITECVENGNEERIN.-ME LICENSE NUMBER I BUS.LIC--.11
COMPANYNAME E-NLML FAX
STREET ADDRESS I CITY,STATE,ZIP I PHONE
USE OF ❑SFD or DUPLEX ❑ MMLTI-FAMILY PROJECT LN WILDLAND ❑ YES I PROJECT IN ❑)'-Es IS THE BLDG AN ❑1 rs
BUI DP:G: Com,TiMIt tCJ kL INTERFACE AREA ❑ ?:-0 FLOOD ZONE ESCHLER HOME? ❑ ?::0
DESCRIPTION OF WORK W45 C11 cAq c�eay-\
TOTAL VALUATION: 3 S00 FI1ED
By my si_nnature below.I certify to each of the follov�ung: I an the property owner or authorized agent to act on the ave read this
application and the information I have provided is correct I have read the Description of l ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to Odin construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of mlicant�gent: Date: `1
PLEMENITAL I-NFORMATION REQUIRED nsr�c�tisE or<I Y
� �'3 Th'E-COIINTER
❑ E3 PRESS '
z PJ r;
J _
❑ A24JOR ,
-AfEPM1L-cA4pp_2011.doc revised 06121111