Loading...
B-2016-2949 CITY OF CUPERTINO,BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2949 10199 RICHWOOD DR CUPERTINO,CA 95014-3313(369 08 041) JOHN SULLWAN CONSTRUCTION INC CAMPBELL,CA 95009 OWNER'S NAME: ROBELLALAN AND LAURIE A TRUSTEE DATE ISSUED:10/19/2016 OWNER'S PHONE:650-353-8720 PHONE NO:(408)247-2147 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#453736 Contractor JOHN SULLIVAN CONSTRUCTION INC Date 07/31/2.017 X BLDG —ELECT X 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: REPLACE 50 GAL WATER HEATER,SAME LOCATION 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 mpensation,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.. Sq.Ft Floor Area: Valuation:.$1000.00 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 369 08 041 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 consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally;the pplicant understands and will comply with all non-point source regula' per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature-'" , r0 Date 10/19/2016 Issued 1111111111111 Date: 10/19/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS: 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. 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:10/19/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. 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 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 Teeo Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety s 5505,2 33, d 34. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agents APPLICANT CERTIFICATION Date:10/19/2016 ` I certify that I have read this application and state that the above information is N NAGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is construction lending agency f r th 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 AR s T' DEC R TION Code,Section 9.18. I understand my plans shall11 bbe e used used as public records. Licensed Signature Date 10/19/2016 Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION MEP 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUP RTINO er (408)777-3228•FAX(408)777-3333•building9cuperlino,o MISC ' 2016 - Z� PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1 1 C �F l V Z VW APN# � l v p ® 1 OWNER NAM @eA f ® t/ JU x 3,5-3 E f t E N 1 . STREET ADD SS CI STATZIP FAX CONTACT E-MAIL STREET ❑OWNER ❑ owNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT LICENS� J LICENSE T BUS.LIC# 3 0 Q NAME STREE $ CI ✓`� / >-T Z P tl � PW 1-57 ARCHITECT/ENGINEER N E !/✓ LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF or DUPLEX ❑. MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ElNO DESCRIPTION OF WORK TOTAL VALUATION: ��OU By my Signature below,I certify to each of the following: I am the property owner or authorized agent to a eowner's behalf. I have read this application and the information I havepr d d is correct. I e read e Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b P din cons tion. autho epresentatives of Cupertino to enter the above-identified operty f spection purposes. SignatureofApplicant/Agent Date:_T/ SU EMENTAL>INFORMATION REQUIRED rx nFFICE USEONLXz',, R THS COC1'TER F"" © EXPRESS. U ❑'STANDARD V 114A,I6 MEPMiscApp_201 1.doe revised 06121111