B-2016-2182 .
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:H-2016-2182
20620 HOMESTEAD RD CUPERTINO,CA 95014-0431(32610 066) NORTHWEST
CLASSIC
CONSTRUCTION INC
NEWCASTLE,CA
95658
OWNER'S NAME: SOBRATO INTERESTS 1 ETAL DATE ISSUED:11/18/2016
OWNER'S PHONE:925-467-3000 PHONE NO:(916)663-1736
i
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#690320
Contractor NORTHWEST CLASSIC CONSTRUCTION INC Date 05/31/2018 X BLDG _ELECT PLUMB i
_MECH_RESIDENTIAL X 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 1
license is in full force and effect. JOB DESCRIPTION:
. 1ST FLOOR;T.I.-ALTERATIONS Td(E)PRODUCE AREA(750 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations: SAFEWAY
1. I have and will maintain a certificate of consent to self-insure for Worker's a
Compensation,as provided for by Section 3700 of the Labor Code,for the
,p
-c performanceel
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 i
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 32610 066 M(Tenant Improvements)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the I
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.
Signature 7, Date 11-18-2016 Issued by:Kim Dunbar
Date: 11/18/2016
OWNER-BUILDER DECLARATI N i
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 roofmg 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) 1
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: 1
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11-18-2016
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 1
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
Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I
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 deemed 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 Code,Sections 25505,25533,and 534.
Labor Code,I must forthwith comply with such provisions or this permit shall ; r
be deemed revoked. Owner or authorized agent: ` /Ltd ..
Date:11-18-2016
APPLICANT CERTIFICATION i
I 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 agenc or 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 .)
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. I understand my plans shall be used as public records.
Licensed
Signature Date 11-18-2016
•
CONSTRUCTION PERMIT APPLICATION
.... ' COMMUNITY DEVELOPMENT DEPARTMENT A BUILDING DIVISION
/w,-,.,,s 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
UPERT1t�€C3 (408)777-3228•FAX(408)777-3333.5uildinq cupertino.or� k62 — 1
❑NEW CONSTRUCTION 0 ADDITION tzrALTERATION/TI 0 REVISION I DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN It i
2pCo.20 1.+1. l�4drinz3S4ead Y2na ' k 0.- D e CO
OWNER NAMEPHO E E-MAIL
SU-iewa5 LAG- VI 255) 46;7.3c va .va•re5 g , .core
STREET ADDRESS CITY STATE ZIP FAX
5511$ 5{mACf4lq , t^c oAl ?,00.4 Plc...sanhvn , c," (14S5$
CONTACT NAME ...._, PHONE E-MAIL
1itNAck4kr l eSVKe;I (53v) 851-t5I4 Sin e 1 e ht3ln65 .V e+
STREET ADDRESS CITY,STATE,ZIP FAX
4384 Maadotor;ew Ades Poa.ei avi, CA g5G14
o OWNER ❑ OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT X.ARCHITECT ❑ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC it
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
_ r
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC IT
13m04-4-krl She l C 242420
COMPANY NAME�? + { t_ ` A E-MAIL
11PT1c i1 Sil&l 1 1 lA f�PG�t��7cER 14 A s' 5 h 1 I e, Y1 t)51ntr's.�C.T FAJC
STREET ADDRESS CITY,STATE,ZIP P�ONE
I� 3il l eA{tO D Vtc . Acres Rtac mal , g scarf - i o�867-1574
zst
l-1,►rrnkans 4-e e„.0 s41,,i 'Pctx ute Prep Ace" : US r.l
J7w -�'lntslnet rav i. ecto;pria.84. t+t� eacIs{i05 'Pc-Aucc-- 0re.i 'Atm,. - o
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3 vve40 vt-61 cl;s()t "'4 sts a+ Galles tar ep,. .S c+ f w Gc -
EXISTING USE PROPOSED USE CONSTR.TYPE It STORIES
g_40:4 X_I. i I. MI-5 I USE TYPE OCC. SQ FT. VALUATION($)
IIXISTG NEW FLOOR DEMO -_ - TOTAL Ttpp,�, Ucri._
AREA AREA AREA NET AREA 1
Pm*? area Ill-3 M i 6 0 25,ctao
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA f J TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH 'j� •
❑AT7'ACE
I
it DWELLING UNITS: ISA SECOND UNIT ❑'YES SECOND STORY ❑YES. (1 {
BEING ADDED? ONO ADDITION? ONO /1 / ,
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES FA.ru f/ L �"-4.47.-_&•.,_,,,,
TOTAL VALUATION:nsTI
PLANNING APPL# �'NO PLANNING APPROVAL LETTER EICHLERHOME? O NO -s - j � - l.' 1 Wv
By my signature below,I certify , -ach o . e following: I am the property owner or authorized ,e tet)act on the property owner's behalf. I have read this
application and the information I ave provii.'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 relati i_to buildin_ onstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: rn a P2,1/16,1
SUPPLEMENTAL INFORMATION REQUIRED '" ,,"A" m A:
New SFD or Multifamily dwellings: Apply for demolition permit for f $Lev- .fir pat„,,,,,, 1
existing building(s). Demolition permit is required prior to issuance of building I '
permit for new building. o ..• -- €- i
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure M •I s
form if any Hazardous Materials are being used as part of this project, I
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
I
_ NVIIZUNMGn l4 V
L S I CS
13/dg.4pp_201./.doc revised 06/21/11