B-2016-3153CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3153
10675 S DE ANZA BLVD STE 4 CUPERTINO, CA 95014-4449 (359 23 033)
KAMET
CONSTRUCTION CO
DALY CITY, CA 94014
OWNER'S NAME: SEAGRAVES WALTER M II ET AL
DATE ISSUED: 11/23/2016
OWNER'S PHONE: 408-768-0668
PHONE NO: (415)699-1488
LICENSED CONTRACTOR'S DECL R TION
BUILDING PERMIT INFO:
License Class B.C10. Lic. #791680
Contractor KAMET CONSTRUCTION CO Date 02/28/2017
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ MECH _ RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
T.I. PREP; REPLACE FLOORING IN OFFICE AREAS_ ONLYNOT
I hereby affirm under penalty of perjury one of the following two declarations:
RESTROOM (1447 8.£) - YES SCHOOL
1. I have and will maintain a certificate of consent to self -insure for Worker's
pensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
/z. 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: $5000.00
APPLICANT CERTIFICATION
certify that 1 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 23 033
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 regulatiops.Rer the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION,
Sig"nature �� D 11/23/2016
Issued by: Abby Ay
OWNER DECLARATION
Date: 11/23/2016
-BUILDER
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)
z. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sce.7044, Business & Professions Code).
Date: 11/23/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BECLASS"A" OR BETTER
s. 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. 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
c
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person 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 unicipal Cade, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Secti`' s 5505, 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: 11/23/2,016
1 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 and state laws
CONSTRUCTION LENDING AGENCY
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.
Licensed
Signature Date 91/23/2016
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
-
+�LJPEt'FiNQ (408) 777-3228 • FAX (408) 777-3333 building(a-cugertino.org
91N 1
El NEW CONSTRUCTION ❑ ADDITION ' ALTERATION TL ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 0 s— - G I r F APN
OWNER NAME t t/ jJ/
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STREET ADDRESS ( O -7 �2��,_&KCITY, STATE, ZIP FAX
CONTACT NAME PHONE 4 -7 T � t4 Yij
STREET ADDRESS l` t CITY, STATE, ZIP / q FAX
,OWNER ❑ OWNER-B`UII..DER 1:1OWNERAGENT El CONTRACTOR ❑ CONTRACTORAGENT 13 ARCHITECT 11 ENGINE ER ❑. DEVELOPER El TENANT
CONTRACTOR NAME LICENSE J BER
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LICENSE TYPE
, li 1 i BUS. L i ( o l 0( V
COMPANY NAME /' ' E-MAIL FAX
STREET ADDRESS l CITY, STATE, ZIP PHONE
ARCHITECTIENGINIEER NAM LICENIISE NUMBER BUS. LIC #
COMPANY NAME _e r� % „ 1 E -MAIL_ ---7_, FAX
STREET?�ADDRESS— u t/ a—) CITY, ST ZIPS F 31, PHONE,%
DESCRIPTION OF"WORK
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USE I TYPE I OCC. I SQ.FT. I VALUATION ($)
EXISTG I NEW FLOOR - DEMO TOTAL
AREA/44--) AREA AREA/. NET AREA
BATHROOM R'T'yHE OTHER -
REMODELAREA /` REMOD LAREA REMODELAREA
PORCH AREA -- DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: D DETACH - - - -
❑ ATTACH
BEING ADDED? [:]NO ADDITION? ONO <
PRE -APPLICATION DYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES EIV.I;D'BY F TOT.L VALUATION: -
PLANNING APPL 4 ❑ NO PLANATING APPROVAL LETTER EICHLER HOME? ❑. NO
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By Iny signature below, I certify to each of the following: I am the property owner or authorized agent to act on tte 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 to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: rl /-.)-/
( ,/ ,I--) e A I
_ New SFD or Multifamily dwellings: Apply for demolition pennit for
existing building(s). Demolition permit is required prior to issuance of building
pernnit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp 2011.doc 7-evised 06121/11
r
SC Design Group.
20370 Town Center Ln.
Cupertino CA. 95014
Project: 10675 S. De Anza
The following revision for the ceiling framing and strapping meets my approval after onsite review of the
modification. In addition they will add 2x blocking at the splitting joints per the existing to new sistering
joist location.
Please feel free to contact my Firm 'for any further questions regarding the project.
Zuishuang Che Susan Chen.
DATE:
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