Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
B-2016-2664
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2664 21862 CORTE MADERA IN CUPERTINO, CA 95014-1129 (326 45 040) GREG L BURRIS SAN JOSE, CA 95118 OWNER'S NAME: PERRY JEFFREY RAND CHRISTINE I DATE ISSUED: 12/09/2016 OWNER'S PHONE: 408-221-0937 PHONE NO: (408)445-8052 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #611123 Contractor GREG L BURRIS Date 01/31/2017 X BLDG _ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X 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`. FRONT, SIDE & REAR ADDITION TO EXPAND 2 BDRMS AND ADD I hereb affirm under penalty of perjury one of the following two declarations: (N) BDRM & BATH (655 S.F.); REMODEL 2 (E) BATHS (118 S.R); I have and will maintain a certificate of consent to self -insure for Worker's REMODEL (E) BDRMS (417 S.F.); RELOCATE FURNACE TO ATTIC; Compensation, as provided for by Section 3700 of the Labor Code, for the REPLACE SEWER LATERAL AND INSTALL PROPERTY LINE performance of the work for which this permit is issued. CLEANOUT; RELOCATE GAS METER. 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: 655 Valuation: $164000.00 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 APN Number: Occupancy Type: and state Jaws relating to building construction, and hereby authorize 326 45 040 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 under tands and will comply with all non -point source regulati s per th CupeFtino Municipal Code, Section 9.18. s 180 DAYS FROM LAST CALLED INSPECTION.: y, Signatur Date 12/9/2016 Issued by: AbbyAygnde r' = Date: 12/09/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 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) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12/_ 9/2016 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 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 370.0 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 Cu rtino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, S tions 255 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Qwner or authorized agent: APPLICANT CERTIFICATION Date: 12/9/2016 1 certify that I have read this application and state that the above information is 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 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 DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 1 2 /912 0 1 6 Si 9 Professional CONSTRUCTION PERMIT APPLICATION mmmah COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, GA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a.cupertinD.orcr — ❑ NEW CONSTRUCTION 9 AUIimoN I I ALTERATiow i T'I nRimmAT-P1ZP?,1rTr-a PROTECT ADDRESS �+� \Z✓ v 'U� C APN p OWNERNAME /*, O o -E\ 0q ,2 -n +11 (1\� , r STFEETADDRESS� CI , STAVES ZI �© Cg G`� I F CONTACT NAME TAIL l' t yr T ] S"RE. t TY, STTlip `-A- CLr "r e EJ OWNER ❑. Oli'1I'ER-BUILDER �OWNER.AGEA'T ❑ CONTRACTOR ❑ CONTRACTORAGENT C3ARRCC.HUECT ❑ ENGINEER ❑ DEVELOPER ❑ TERAN'r COI,1TRACTOR NAME � I c� LICENSE NU1vI5ER / I ( ' `� LICENSE TY F. ('/(Jl L��`) BUS. LIC 4 � �' /_ I �[�/(Ja�� COI�4PRNYNAME �d E -RAIL �Giib�CC FAX STPLM ADDRESS 1 L� zlil-)—een-)l CI 57AT , ZI IPliolmq.8bf <�4 j I%w*!1.g ws - - ' LT�� . BUS. LIC n COriP 3QANjE VCQ IL FAX STREET ADDRE 5 swt `Lu•0 CITY, STATE, ZTP PHD DESCRIPTION OF 1ArDRIC E•XISTINGUSE PROPOSED USE CONSTR..'fYPE �#STORiES - USE TYPE OCC, SQ.FT. VALUATION (S) EXISTGfU . • ARTA O .. ' K NEW FLOOR AREA i_1 DEMO1.�K1J. AREA TOTAL NETAREA Y� BATBROOhi I:rrCh1ZN REMODELAREA t RE64ODELAREA PIS iDECR OTHER - - REMODELAREA J - PORCH AREA AREA j(� 0 TOTAL DECKJPOORCH AREA GARAGE AREA: DETACH. F�.\r ATTACH �D1�'-,j'E UNG UNITS; IS A SECOND UNIT D YES SECOND STORY [] YES �- t BEING ADDED? ®NO ADDITION? JE No PRL -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN TPTAL VALUATION: PI.ANX9340APPLO. I jNO PLANNINGAPPROVALLETTER EICHLERHOME? NO _ = a(q (530 By my signature below, I cel each of ollon the property owner ze Qe act oil the property owner's beh . I have read this application and the info ati 'ori s coir . I have read the lies ' tion 0 o rift' it is accurate. I agree to comply with all applicable local ordinances and state ws rela ' g to build stT•uctio . I" r ze I prese e upertino nter ov identi:3 roer[y for inspection purposes. Signature ofApplican gent: ate: ti SiIPPLEA I� tFG- CHECICTYPE_: _ _ _ _- —-ROIITI7TG SI,iP c r _ _....:_.....:_ ._.4 __._...c?Fr:•,%•-;;max'.::--. ,:c-...,_,..-,._„-_- p o� sx THE calrnT> R iz- ❑ suTLDI tGPLAi` xai�> t; _ New SFA or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition pennit is required prior to issuance of building pBrmit for new bulldulg. Li E�.PRE$S . - - -_ ❑ PLA11ilIi�GPL4i REI IEP. - - - Commercial Bldgs:: Provide a completed hazardous Materials Disclosure z.❑ sTAT\n4RD —=��. -_ - - ❑ ruBltc iioRl.s — form if any Hazardous Materials are being used as part of this projeCt Q LARGE. 'FIRE DEPT; ="- _Copy of Plannina Approval Letter or Meeting with Planning prior to IIAIDR i�5L�3TAR] SEiiERDISTRICT STIbmittalofBuildillgPermit application. - r° �. . __; Bldg.App �011.doc remised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2664 21862 CORTE MADERA LN CUPERTINO, CA 95014-1129 (326 45 040) GREG L BURRIS SAN JOSE, CA 95118 OWNER'S NAME: PERRY JEFFREY R AND CHRISTINE I OWNER'S PHONE: 408-221-0937 LICENSED CONTRACTOR'S DECLARATION License Class 13 Lic. #611123 Contractor GREG L BURRIS Date 01/31/2017 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: t. 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 DATE ISSUED: 12/09/2016 PHONE NO: (408) 445-8052 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FRONT, SIDE & REAR ADDITION TO EXPAND 2 BDRMS AND ADD (N) BDRM & BATH (655 S.F.); REMODEL 2 (E) BATHS (118 S.F.); REMODEL (E) BDRMS (417 S.F.); RELOCATE FURNACE TO ATTIC; REPLACE SEWER LATERAL AND INSTALL PROPERTY LINE performance of the work for which this permit is issued. I CLEANOUT; RELOCATE GAS METER. I have and will maintain Worker's Compensation Insurance, as provided for by REV #1 - COFFERED CEILING DESIGN CHANGE AND FRAMING - Se�bn 3700 of the Labor Code, for the performance of the work for which this ISSUED 7/18/2017 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 Code, Section 9.18. Signature Date 7/18/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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: t. 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. x. 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 7/18/2017 Sq. Ft Floor Area: 655 1 Valuation: $164000.00 APN Number: Occupancy Type: 326 45 040 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 12/09/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 7/18/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with theCup tino Municipa Chapter 9.12 and the Health & Safety Code, Se tions 255 5, 25 3, and 34. Owner or authorized agent: Date: 7/18/2017 CON TRUCTInVT, I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1� ( (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.or4 CUPERTINO ❑NEW CONSTRUCTION ❑ADDITION ❑ ALTERATION/ TIVISION/DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS •"' AP. OWNER NAME PHONE u(� �%7 I (Y� 1� E-MAIL rtn" � STREFTADDRESS n CITY, STATE, ZIP C FAX 12 CONTACT NAME PHOYI0, E-MAIL I /'_ >: ^�O C/ STREET ADDRESS CITY, STATE, Zlf: _ f� � FAX ❑ OWNER 11OWNER-BUILDER❑ OWNER AGENT I$ ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARcHrrECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME' LIC LICE E TYPE BUS. LIC # S 1J ftZ COMPANY NA E-MAIL /i 6 FAX S-1 REET ADDRECD CITY, STATE, ZIP PHONE ARCIIfI'ECT/ENGINEERNAME LICENSENUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK , EXISTING USE PROPOSED USE CONSTR. T177 --j-777= STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH H ATTACH k DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ONO PRE -APPLICATION [3 YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIXED BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? []NO 14t,"'a, By my signature below, I certify to each of the following: I am the property owner or authorized agent to ac on the operty owner's behalf. I have read this application and the information I hav 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 ilding ruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. ti Signature of ApplicanUAgen . Date: SUPPLEMENTAL A I U1RED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ 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 PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS 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 ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11