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B-2016-2584 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT Nth B-2016-2584 20074 WHEATON DR CUPERTINO,CA 95014-2340(316 23 085) HOMEOWNER BUILDER OWNER'S NAME: MCNAIR TODD HAND WHITNEY H TRUSTEE DATE ISSUED:10/05/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor HOMEOWNER BUILDER Date X BLDG _ELECT _PLUMB — 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 license is in full force and effect. JOB DESCRIPTION: KITCHEN REMODEL-M,E,P(195 S.F.);REMODEL DINING ROOM I hereby affirm under penalty of perjury one of the following two declarations: (178 S.F.);REPLACE 2 WINDOWS TO 1 WINDOW;REPLACE SLIDER 1. I have and will maintain a certificate of consent to self-insure for Worker's _LIKE FOR LIKE Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1-VAULTING CEILING-ISSUED 11/10/2016 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. Sq.Ft Floor Area: Valuation:$100000.00 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, APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 316 23 085 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 PERMITEXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.. Signature Date 11/10/2016 Issued by:AbbyAyende Date:10/05/2016 OWNER-BUILDER DECLARATION 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 i. 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 ompensation,will do the work,and the structure is not intended or offered for inspection. ale(Sec.7044,Business&Professions Code) av 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:11/10/2016 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 �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 a 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 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 od• Sec qii ns 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ,----0l / , L be deemed revoked: Owner or authorized agent: APPLICANT CERTIFICATION G Date:11/10/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LE I IN AGENCY, correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction le,.ng 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,Sectio 1 9. '`. I understand my plans shall be used as public records. I M Signature nature f Date 11/10/2016 Licensed �� r Professional Liv I -7,b ,25$q i CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONB k,,,t.I,�� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building[ cupertino.orq Li NEW CONSTRUCTION ❑ ADDITION G ALTERATION I TI - ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ./14/x.t z t4)Iy L' �/ Itis. ;t✓f�l y' APN# .../24907q -GID `7 h GL kin 1 3/112-2.3---n� " , OWNER NAME ��q1�A fillet��`[[[ f rte /} '7A -�`/� (Q1 I LJ f4C Ci r PHONE( J0 yl /9 138V toil. r r+�c-�t4 rj'C�l:�}yvt.LR&'�-,i� ; AV What 1 J: / STREET ADDRESS .... C�'Y S'rATFy�7f,Ppl1 FAX fV}C��r "ifla f p,�r 1 A Jam[fttr pj PHONE E-MAI CONTACT NAME UVY! i'VI",V t!`"' ' STREET ADDRESS 219074' 1/t1 LeGrr cJ, p t/-t CITJj,STA/Z..7t 6 C `-'/�I`f FAX ❑OWNER OWNER-BUILDER ❑ OWNER AGENT Cl CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER ❑ DEVELOPER 0 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.Licit COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIPj7d _ 16C/PHONE DESCRIPTION OF WORK ;5,re", \ 9��l •J g / mem ce�C(S YE h0I7l�lrn r oeivu it 4 a P..-..„, if4.wove,/ 1 D 'e e .h i 1\c ova! !�'.. . k � w • t - 1` kola-� . >u � r s � �► B (fit! �e.�o�l � 1j.� Prime- W t Site(( , 4Ifrvii 1 OWL % M.'s EXISTING USE PR POSEL}SE • CON,TR.TYPE if STORIES - - - delt ' g ,Lt.�.tglAD V-- , ( USE TYPE C. SfT) VALUATION(S) EXISTO�ry) �J NEW FLOOR DEMO TOTAL AREA �1 ig[ AREA AREA K NET AREA v7 BATHROOM U - KITCHEN OTHER Vile REMODEI.AREA 0 REMODEL ARE REMODEL AREA j 7b5p PORCH ARE DECK AREA TOTAL DECK�/jP.ORCHAREA (IAAJ^R•AII',EAREA: DETTACH i. 1 f. ! �f-''J� TTACII {. B DWELLING UNITS: ISA SECOND UNIT [ YES SECOND STORY DYES ,i 1 BEING ADDED? )O ADDITION? s�'NO PRII-APPLICATION DYES IF YES,PROVIDE COPY OP IS THE BLDG AN ❑YES RECD BY: TOW,VALUATION: PLANNING APPL# RIO PLANNING APPROVAL LETTER EICHLERHHOME? NO A VAC/Lk -- °1 y i �/"t J By my signature below,I certify to each of the following: I am the property owner or authorized agent to a t on th 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 verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t.,En ildinliconstru ti.I. au Izc representatives of Cupertino to enter the abode t7 tifpi`p-(�hp�operty for inspection purposes. t� Signature of Applicant/Agent: / A Date: ,1 (p i s , SUPPLEMENTAL INFORM V ON REQUIRED PLAN CHECK TYPE ROUTING SLIP New SPD or Multifamily dwellings: Apply for demolition permit for ]L. LIVER-THE-COUNTER 0 BUILDING PLAN REVIEW existing building(s). Demolition'permit is required prior to issuance of building permit for new building. ` 0 EXPRESS 0 PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD Q PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE Cl FIRE DEPT . _Copy of Planning Approval Letter or Meeting with Planning prior to p MAJOR 0 SANITARY SEWER DISTRICT Pr submittal of Building Permit application. 1 ❑ ENVIRONMENTAL HEALTH BidgApp_2011.doc revised 06/21/11