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B-2016-3152 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3152 10998 SYCAMORE DR CUPERTINO,CA 95014-6560(342 56 030) FURLANIC CONSTRUCTION REDWOOD CITY,CA 94061 OWNER'S NAME: GOTTLIEB ROBERT S AND MCDONOUGH JILL J TRUS DATE ISSUED:11/21/2016 OWNER'S PHONE:650-575-7339 PHONE NO:(650)888-0644 J.ICFNSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class U Lic.#675889 Contractor FURLANIC CONSTRUCTION Date 08/31/2017 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: BATHROOM REMODEL-MASTER BEDROOM(125 S.F.);GUEST I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM#1(87 S.F.);GUEST BATHROOM#2(87 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 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:$74000.00 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 342 56 030 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 Cu.drti 6 Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. k Avasollw Signature Date 11/21/2016 Issued by:AbbyAyende �. Date: 11/21/2016 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 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 compensation,will do the work,and the structure is not intended or offered for inspection. N. sale(Sec.7044,Business&Professions Code) `i 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:11/21/2016 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. 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 lJ\ 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 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 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal„ ,de,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2550 and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall -- be deemed revoked. Owner or authorized agent: /1,6,” „-,-,---5: 7– , . APPLICANT CERTIFICATION j,-Date:11/21/2016 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 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.- I understand my plans shall be used as public records. Licensed Signature Date 11/21/2016 Professional b•- ?.�.Ot(Q- 2.,. ,/ CONSTRUCTION PERMIT APPLICATION VCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,i", , 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 -4,, (408)777-3228•FAX(408)777-3333•buildinq(a cupertino.orq CUPINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# , APN 41YPROJECT ADDRESS j ,g` n6g an OWNERNAME PHONEE-MAIL ? �?� ycvTtc�ree/ine- )6/1)701,4 STREET ADDRESS CITY, STATE,ZIP FAX Lz, CONTACT NAME PHONEte. E-MAIL era FAX STREET ADDRESS CITY,STATE,ZIP XOWNER ❑ OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER. 0 TENAIL.T a CONTRACTOR NAME- rZ7S' flsrv� LICENSECPu BER � LICENS YPE FAX LIC# i COMPANY NAME ^<lfZ. 4../(c_ e_ati 5.1._ � E-MACLLvtJ al-1-4—C r- ''C✓LtL_I STREET ADDRESS CITY,STATE,ZIP PHONE _ �/ SS'.CJ -1 -s' a-, 7- X573 :G� ARCHITECT/ENGINEER NAME rzCs iZr7 LICENSE NUMBER BUS.LIC# f COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 2� ( f 'i- S' s� 2� 1 l3 C7 J6./!✓% /1lCS `LC.�C ; UP r R 4 p 6" l t' U3Bkl a‘ P u✓��.,s f4/6, /627—e.Cm,c . 17 7-1 L EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES / USE— TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL [ _ - I AREA AREA AREA. NET AREA BATHROOM g p�y� KITCHEN OTHER - REMODEL AREA ry/( I REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑DETACH 0 ATTACH #DWELLING UNITS: ISA SECOND UNIT El YES SECOND STORY ❑YES BEING ADDED? 0 NO ADDITION? 0 NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE(~P ED$Yf , TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? DO NO - By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on, e property owner's behalf. I have read this ' application and the information I have provided is correct. ..ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build•g,co.structis+. uthorize representatives of Cupertino to enter the above-identified> property for inspection purposes. Signature of Applicant/Agent: / Date: ( Z% 'C; SUPPLEMENTAL INFORMA ON REQUIRED ,PLANCH>iCKTYPz /-? fir;, ;',ItOIITSNSLIE,,,, ., New SFD or Multifamily dwellings: Apply for demolition permit for ❑.oyERTIE-COUNTER , - ❑,BIALDJNG FLAX VIEW✓,.,,. existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ �xrxEss L� I ANNING P,L REVI W Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ 'PUBLIC IOR:FS form if any Hazardous Materials are being used as part of this project. ' ❑°LARGE ' ❑ FIRE DEPT.- Copy of Planning Approval Letter or Meeting with Planning prior to ❑,.MAJOR ❑ SAhITARYSEw>RDISTRICT submittal of Building Permit application. ';n 1,E iNVHLONMENTAL HEA'L'lTI BldgApp_2011.doc revised 06/21/11