B-2016-2607CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2607
10170 N BLANEYAVE CUPERTINO, CA 95014-2330 (316 31 023) ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'S NAME:
License Class a Lic. #909433
ContractorALI'S CONSTRUCTION & REMODELING INC Date 01/31/2018
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.
I hereby affirm under penalty of perjury one of the following two 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.
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.
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 CodA%�Sgction 9.18.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
DATE ISSUED: 12/05/2016
PHONE NO: (408) 441-0967
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
1 ST FLR - 2 BEDROOMS / LIVING RM / DINING RM / 1/2 BATH
ADDITION (988 S.F.). REMODEL (E) SFD - 1,908 S.F. (INCLUDING (N)
TRUSS ROOF SYSTEM, REPLACE A/C, FURNACE, WATER HEATER
& UPGRADE PANEL 200 AMPS); NEW PORCH (30 S.F.)
04/20/2017 -DEFERRAL #1 - TRUSSES - ISSUED 5-15-2017
05-12/2017 - REV#1,— EXISTING FOUNDATION AT GARAGE, FRONT
EXTERIOR WALL, AND (1) GUEST BEDROOM EXTERIOR WALL TO
REMAIN; ADD CEILING BEAM ALONG BATHROOM ADJACENT TO
GUEST BEDROOM.ISSUED 5-24-2017
Sq. Ft Floor Area: 988 Valuation: $400000.00
APN Number: Occupancy Type:
31631 023 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
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.
I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's Date: 05/24/2017
Compensation, 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.
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.
Date 05/24/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, 25
Owner or authorized agent:
Date: 05/24/2017 COT,��CTI DING
AGENCY
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.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2607
10170 N BLANEYAVE CUPERTINO, CA 95014-2330 (316 31 023)
ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'SNAME:
DATE ISSUED: 12/05/2016
OWNER'S PHONE:
PHONE NO: (408) 441-0967
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ¢ Lic. #909433
ContractorALI'S CONSTRUCTION & REMODELING INC Date 01/31/2018
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:
1ST FLR - 2 BEDROOMS / LIVING RM / DINING RM / 1/2 BATH
I hereby affirm under penalty of perjury one of the following two declarations:
ADDITION (988 S.F.). REMODEL (E) SFD - 1,908 S.F. (INCLUDING (1)
1. I have and will maintain a certificate of consent to self -insure for Worker's
TRUSS ROOF SYSTEM, REPLACE A/C, FURNACE, WATER HEATER
Compensation, as provided for by Section 3700 of the Labor Code, for the
& UPGRADE PANEL 200 AMPS); NEW PORCH (30 S.F.)
performance of the work for which this permit is issued.
04/20/2017 -DEFERRAL #1 - TRUSSES - ISSUED 5-15-2017
p, A Vz. I have and will maintain Worker's Compensation Insurance, as provided for by
05-12/2017 - REV#1 - FOUNDATION
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area: 988
Valuation: $400000.00
permit is issued.
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
316 31 023
R-3 (Custom)
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 CSection 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/15/2017
Issued by: KIM DUNBAR
Date: 12/05/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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. 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: 05/15/2017
1 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
z. 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
3. 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 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: 05/15/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECL ATION
and will comply with all non -point source regulations per the Cupertino Municipal
a r
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 05/15/2017
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: i PERMIT NO: B-2016-2607
10170 N BLANEY AVE CUPERTINO, CA 95014-2330 (316 31023) ALI'S CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
LOWNER'SNAME: I (DATE ISSUED: 12/05/2016 I
OWNER'S PHONE: I I PHONE NO: (408) 441-0967
License Class a Lie. #909433 i
ContractorAL1'S CONSTRUCTION & REMODELING INC Date. 01/31/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
C mpensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
,/performance
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,
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 a� plicant understands and will comply with all non -point
source regula9�1'1per tb.e 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).
I 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. 1 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.
s. 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
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
BUILDING PERMIT INFO:
X_ BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL_ COMMERCIAL
JOB DESCRIPTION:
1 ST FLR - 2 BEDROOMS / LIVING RM / DINING RM / 1/2 BATH
ADDITION (988 S.F.). REMODEL (E) SFD -1,908 S.F. (INCLUDING (1)
TRUSS ROOF SYSTEM, REPLACE A/C, FURNACE, WATER HEATER
& UPGRADE PANEL 200 AMPS); NEW PORCH (30 S.F.)
Sq. Ft Floor Area: 988 I Valuation: $400000.00
APN Number: Occupancy Type:
316 31 023 1 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Aeti nde
Date: 12/05/2016
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 of Applicant:
Date: 12/5/2216
BETTER
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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Co_ ecdons 25505, 25533, and 25534.
Owner or authorized agent:
Date: 12/5/2016
UONSTRUCTION LENDING AGENCY
1 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
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING REVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255 REVISION V '�/
I_- . 4
(408) 777-3228 •FAX (408) 777-3333 • buildinga(7cupertino.ora11 �'^1
Gt.IF'ERTfNO 17 '"
❑ NEW CONSTRUCTION ❑ ADDITION ❑ AL. 0N/T1 ❑ REVISION /DEFERRED ORIGINAL PERMIT ii
PROJECT ADDRESS A /A
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR FCONTRACTORAGENT 11 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORLICENSENW&
LICENSE TYPE
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COMPANY NAME
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DESCRIPTION OF WORK
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EXISTING USE
PROPOSED USE
CONSTR. TYPE
# STORIES
USE
TYPH
OCC,
SQ.FT,
VALUATION (S)
EXISTG
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DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODELAREA REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA; DETACH
❑ ATTACH
I
R DWELLING UNITS:
IS A SECOND UNIT Q YES
SECOND STORY [] YES
BEINGADDED? E]NO
ADDITION? [INO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS TIDE DLDG AN I] YES_
!I I 1 .�.
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TOTAL VALUATION:
PIANNINOAPPL# ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑NO
_
_
(
By my signature below, I certify to each of the following: I am the property owner or authrized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description o rk and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction, I authorize representa ' of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: --
SUPPLE IALMFORMATioNR.EQUIRED
_.:�PLArN4HECKT'YPE;�rr ....e;�.-x
.. �iStri'B�CSLTP '^ .
New SFD or Multifamily dwellings; Apply for demolition permit for
❑ gv$R�Bx coul�r tx. s
CI'BurLn LAIR–f
existing building(s). Demolition permit is required prior to issuance of building
-
permit for new building.
D EXp�SS
f'LhlvAmTGYLAIV REVIEW tT
Commercial Bldgs: Provide Hazardous Materials
_ a completed Disclosure
Q srAhDAR1I' r
PIIeL7GvoRxs
To—nn if any Hazardous Materials are being used as part of this project.
❑ 7`.ARGEr-' _._ L,�. - �
L.7 FIRE DEPT �
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJAk
ORS x :"
.
�I�.. SATQITABYSEwER])ISTRZ�7
submittal Gf Building Permit application,
s r
_
BldgApp_201 Ldoe revised 06/21/11