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B-2016-2966 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMITNO:B-2016-2966: 803 KIM ST CUPERTINO,CA 95014-4322(359 20 001) DONE RIGHT HOME REMODELING INC SANTA CLARA,CA 95131 OWNER'S NAME: PURCELL TERRANCE J AND CARLEEN F ET AL DATE ISSUED:10/21/2016 OWNER'S PHONE:408-921-7229 PHONE NO:(800)816-0000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class$ Lie.#1002689 Contractor DONE RIGHT HOME REMODELING INC Date 04/30/2017 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: 1 ST FLOOR BATHROOM REMODEL GUEST E.M.P(40 S.F.);2ND I hereby affirm under penalty of perjury one of the following two declarations: FLOOR BATHROOM REMODEL MASTER-E.M.P.(40 S.F.) 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 Cade,for the performance of the work for which this permit is issued. j 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;$25000.00 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 359 20 001 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 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. r ('Signature 1efG� Date 10/21/2016 Issued by:Kim Dunbar Date: 10/21/2016 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 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 ofAppiicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/21/2016 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. 1 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 wilt 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 Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: . APPLICANT CERTIFICATION Date:10/21/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending 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,Section 9.18. 1 understand my plans shall be used as public records. Signature Date 10/21/2016 Licensed Si 9 Professional EONS i RUC TION PERMIT APPLICATION ,.� COMMUNITY DEVELOP10ENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,, CA 95014-3255 r (108).777-3228 • FAX(408)777-3333 b1jIIdIno0 cuoortino.org CUPIER [NO- .- ❑NEW CONSTRUCTION ❑ .ADDITION ALTERATIO t J U ❑ REZ%ISION/DEFERRED ORIGIN Al PERMIT r pedfrio CAPROJECT.4D RESS c3?v r ,— Off'SEP .4 dE IF9 �� 1 I PHO' 'sl� 7e I® E-MAIL CITY,STATE;ZIP, ST? tT.JDRES CONTACT?..h E PHO:iE E-ML L � ,� t STRE T RE 1M Ave i Z6ITY, T4TE,Z P y m a.w .4 cc OWNER ❑ OV,N--t-BIJT DER ❑ 0`+'X12 AG-.T ❑ C0N7R-SCTOR X CO RACTOR AGE)T ❑ AR.CF7ECT ❑ENG-7EE'!R ❑ D LLO?ER ❑ TENANT CO " 4CTORNOnneAh4' ID14 tt-mille - LIC ISE?\'i,�BER LICEI\7SETYPE BU-S*LIjonC' Vemmxkl� � COINUA Y X.A-hd FAX _ ► �► 7D Ss * e,06 CITY:STATE;Z-. otetc � � ` � � q �TECTrNG ' R'N \4 �[_ LICENSE ti� 3ER b, Aai6�Y11 l elYYi�'de4 BLS LIC C _ �� s _ CEO TY A1,` Q WlCad,� I E-I\L-TL FAX V = 5: STREETADDRESS )) ��11IV d SY,ST.4 13 �$ P.0 2�( f DESCP.IPTIO?;'OF'A'0RR s r l• ` 4 ��, e' `� J ct r�+q t (. `.UA1 `t 0 r00W� `IRSe�e on EXISTING.USE PROPOSED USE CONSTR.iZPE =STORIES - - - t�m � USE TYPE OCC. I SQ.FT. I VALUATION(S) M•�: spa EXISTG KEW FLOOR DE1,40 - TOTAL AREA AREA AREA N'ETAREA l B.4TrRO4 O . KITCHEN OTHER R..='T GEL AREA �I M40DEL AREA I =1140DEL AREA 216 010 PORCHAKEA DECICAREA TOTALDECICTORCHARE4 GAR4GEP.REfi: ❑DETACH - ❑ATTACH DRELLL'`G LOTS: ISA SECOND LNIT ❑1'=S SECOND STORY [1YES BELNGAD'DED? E]\-0 ADDITION? ❑NO PR_ F°LiC.4TICN ❑ =S IF`'ES PROVIDE COPY OF I IS THE BLDG AN ❑1'ES jD$� OTAL V.A.L'li 4��10\: PL.A\"A"1G.i??L. ❑\O ??t\''\i\G.;PPROVALLETTER EICHLER HOME? No By my, si_na-wre below,I certi--to each of the following: I zip the property owner or authorized a ent to act on the propertY OwDer`s behalf. I have read this application and-,be information.I have provided is correct. I have read,be Description of\r,'ork and v riiy it is accurate. I a=ree to comply with all applicable local ordinances_and state laN s relating to buildme construction. I,authorize representatives of Cupei2ino to enter the above-identified property fol inspection proposes. Sia nature ofApplicant!Agent. Date: C9 SUPPLERZENTAL INFORMATION REQUIRED PROLTING 'Ne,y S%D or Aultifaii7i]y dwell'ls: .4pplV for de tojition p rnif for k a c'•,ob,nldinR(S�. De1T OIiiTOII pei! if]s reOLire prior tC issuance.Ofbu ldlnQ O\ER TFC COL'\TEPN BL LDI\GPL4 RESTERS epi ,._ pernit for new building. PLS\\L GPL4\RE1IE\3 \ 4' t x w _Commercial Bldgs: Protide a completed HazardousMaterialsDisclos're D cIA D RD> pLBLIC\TORI S fbia 1 if any Hazardous Tvimri als are b eine used as pari OI thisz prOj2Ct. ❑ T SRGE FIRE DEPT Copy of Planning Approval Letter or Meeting%vith Planning prior to Submittal of Building Permit apj�lication. � zL1JOR � L7 ��\TT�Rl S£�3ERDI�TRICT �: r= Bfc;�pp_2OILa'oc revised 0612Y11