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B-2016-3215CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMITNO: B-2016-3215 20771 MCCLELLAN R) CUPERTINO, CA 95014-2966 (359 16 012) SUNSATIONAL SUNROOM TRACY, CA 95376 OWNER'S NAME: LICENSED CONTRACTOR'S DECLARATION License Class Q Lic. #834696 Contractor SUNSATIONAL SUNROOM Date 03/31/2018 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. affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's DATE ISSUED: 12/05/2016 PHONE NO: (408) 439-4514 PERMIT INFO: X BLDG ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (I) REAR PATIO ENCLOSURE (260 S.F.) V Compensation, as provided for by Section 3700 of the Labor Code, for the f, performance of the work for which this permit is issued.... %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: $12000.00 APPLICANT CERTIFICATION I 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18, Date 12/5/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: 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. 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. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 12/5/2016 APN Number: Occupancy Type: 359 16 012 PERMIT EMPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 12/05/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofApl Date: 12/512016 "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cope. no Municipal Code, Chapter 9.12 and the Health & Safety Code, S 'ons 25505, 25533, and 25534. Owner or authorized agent: Date: 12/5/2016 N R L A - I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingCd-)cupertino.om ❑ NEW CONSTRUCTION j9ADDITION ❑ ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PF,RMIT # PROJECT ADDRESS9V �j �%' C J� 0 V 1 APN r t c ?t/j OWNERNAME 6 , �2f 94n94nC, }o 'l �'j / �� p� PTI) 6?(, �E-MAIL `c - I �j tl STREET ADDRESS / J] CITY, STATE, ZIP j FAX 1 G Lcl o CONTACT NAME G PHONE <;/ E-MAIL {110 -at" cam - STREET ADDRESSW�j CITY, STATE, ZIP g °/ FAX t it t OWNER El OWNER -BUILDER ❑. OWNER AGENT - t!�CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER r LICENSE TYPE BUS. LIC # 3 P 1 COMPANY NAME) em E-MAIL FAX STREET ADDRESS /\" i /f j j CITY, STATE, ZIP Al, �% j PHONE �✓ f,�di I Y !�� Y&L ARCHITECTIENGINEER NAME � ) ( V.5 LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE. CONSTR. TY=#STORIE§ USE TYPE OCC. SQ.FT. VALUATION ($) EXISTGty NEW FLOOR DEMO TOTAL AREA / AREA AREA NET AREA BATHROOM KITCHEN REMODELAREA REMODELAREA OTHER REMODELAREA _n/ - - PORCH. AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH k OE] -ATTACH # DWELLING UNITS: IS A SECOND UNIT [] YES SECOND STORY YES - BEING ADDED? -I, I NO ` PIT ADDITION? I PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ®YES „ ' " " . •- TOTAL VALUATTIION:. PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each I amthe property owner or authorize agent on the property owner's behalf. I have read thisapplication /t�hollowing: and the"infortnation 1 have pris correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to builnstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT Y INFORMATION REQUIRED . PLAN:ceKTi> .' Ro[rrlNc slr ❑ " OVER TiilrCflIINR © BIIILDI G PLAN YiEW" New SFD or Multifamily dwellings: Apply for demolition .permit for — existing building(s). Demolition permit is required prior to issuance of building permit for new building.' ❑ !EXPRESS ,.. ..; ❑ 'PLANNING LAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑f STANDARD , ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑; LARGE'. ❑ kD2E DEPY _ Copy of Planning Approval Letter or Meeting with Planning prior to 0` MsoR" �`° ." ❑ snNTrARYSEwERVISTRICT submittal of Building Permit application. ❑ FNVIRONMENTAIL-DT LTH " BldgApp 2011.doa revised 06121111