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B-2016-3286 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3286 22315 CARTA BLANCA ST CUPERTINO,CA 95014-1008(326 13 054) BATH FITTER - NORTHERN CALIFORNIA SACRAMENTO,CA 95834 OWNER'S NAME: INFANTINO PAUL A TRUSTEE DATE ISSUED:12/16/2016 - OWNER'S PHONE:408-245-8242 PHONE IilO:(514)592-0990 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lic.#988525 Contractor BATH FITTER NORTHERN CALIFORNIA Date 11/30/2017 X BLDG _ELECT X PL 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: MASTER BATH SHOWER; PLACE SHOWER VALVE;INSTALL I hereby affirm under penalty of perjury one of the following two declarations: SEAMLESS WALL OVER(E) ILE is 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. ll .. 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:$1000.00 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: Occupa cy Type: and state laws relating to building construction,and hereby authorize 32613 054 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 WORK IS NOT STARTED may accrue against said City in onsequence of the granting of this permit. WITHIN 180 DAYSF PERMIT ISSUANCE OR Additionally,the app' : t nde -ands and will comply with all non-point source regulations.. / - p- ino Mu ipal Code,Section 9.18. 180 DAYS FROM L ST CALLED INSPECTION. Signature I�/� '1, Date 12/16/2016 Issued by: Date: 12/16/2016 I AA 4t4 IL I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: All roofs shall be inspected prior tany 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. 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:12/16/2016 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. .._ .:1 S U 1 . 1Z_ 1 1 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous mate ' Is 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 Co'e,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cu•ertino 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 5532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I u•e equipment or devices which emit hazardous air contaminants as defined by th•Bay Area Air 8, ality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupe ' � • if cipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co e,Se k El ns 2 fi 15,2553 nd 25534. Labor Code,I must forthwith comply with such provisions or this permit shall /// be deemed revoked. Owner or authorized agent J, APPLICANT CERTIFICATION Date:12/16/2016 I certify that I have read this application and state that the above information is ` n ` '+`I1 t` correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a coristructi en lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is ssued(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 : t 11 Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 12/16/2016 r1/ GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION -4,1.1,4.4, ` 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buiidinc cupertino.orq M IS C U - 2a/ 728,6 B. LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MIS ELLANEOUS ••• AAA PROJECT ADDRESS /S----- /1�/_ Z _% M yT�_ APN# _3 2_�` ) -3 - / .) • OWNER NAME ' I� 4 /// rte' .l A We PHONE4I '1 15- FZ/ Z 1�E 'Z _J"sryL YI►eP' f:! o. STREET ADDRESS / f z / fllt Li- 1 /..,-0 CONTACT NAME •' E- .; G/.A tgr1/ pi._ hili' AA 3 W,i /G,7- �. STREET AD TRESS CITY,STATE,ZIP FAX .e 41- ,i--• — ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT r CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT H ENGINEER IDDEVELOPER ❑ TENANT CONTRACTOR NAME• • 11 s LICENSE TYPE BUS.LIC#,, _�J/1 r _.,1 4 A- 62 0/2 - G %Z)iy - COMPANY NAME S E-MAIL FAX V3 '46- STREET ADDRESS / 3 j 4... ', /r/%ii / CITY,STATE,ZIPi ! p �� PHONE i0i ' //// ARCHITECT/ENGINEER NAME /I LICENSE NUMBER G BUS.LIC# 6�N G�f COMPANY NAME E-MAIL FAX __ STREET ADDRESS CITY,STATE,ZIP ■ PHONE USE OF ❑SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA, ❑ NO FLOOD ZONE 0 NO EICHLER HOME? ❑NO DESCRIPTION OF WORK S /- / //j Z''/,. � // 2//�6 ` ftli ✓f171/_._ l/C� C-C"--) T71-G. TOTAL VALUATION: + /1/r) ..;r a= •641'4 tea_ lf!!v `n2'"� --- f By my signature below,I certify to each of th- o in_ I am the property owner or autho d agen to act o trlowner's behalf. I have read this -- application application and the information I have prov+. con: , ,e read the Description of Work and verify it is accurate. I a -e to comply with all applicable local i""7 Era ordinances'and state laws relating to builj�• ��` 1. I authorize representatives of Cupertino to enter the above-'denti i ed property for inspection purposes. Signature of Applicant/Agent: / ,' /' r Date: fi r i/' SUPPLEMENT AL INFORMATION REQUIRED OFFICE USE ONLY , H kir O -COUNTER ' D EXPRESS D STANDARD._ U © LARGE- - , Sn - 0 MAJOR • ME'MiscApp_2011.doc revised 06/21/11