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B-2016-31506 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3150 7668 NORMANDY WAY CUPERTINO, CA 95014-5253 (366 17 054) BUILDCOM CONSTRUCTION SAN JOSE, CA 95111 OWNER'S NAME: CRUM WILLARD L TRUSTEE & ET AL DATE ISSUED: 01/03/2017 OWNER'S PHONE: 408-708-6546 PHONE NO: (408) 605-9382 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lie. #966238 Contractor BUILDCOM CONSTRUCTION Date 09/30/2017 X BLDG —ELECT _ P,LUM B 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: KITCHEN REMODEL (160 S.F.); BATHROOM REMODEL; HALL I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM (40 S.F) MASTER BATHROOM (50 S.F.); REPLACE 1. I have and will maintain a certificate of consent to self -insure for Worker's FURNACE - ATTIC Compensation, as provided for by Section 3700 of the Labor Code, for the ,,performance of the work for which this permit is issued. 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: $70000.00 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: Occupancy Type: , and state laws relating to building construction, and hereby authorize 36617 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 IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature���� Date 1/1912017 Issued by: Abby A e� nde OWNER-B1M,DER DECLARATION Date: 01/03/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the REPROOFS 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 properly, 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: 201 1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i. 1 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. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous i 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. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 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 255 5, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ;Owner or authorised agent: APPLICANT CERTIFICATION Date: 1/19/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws 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 DECL R TION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 1/19/2017 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3150 7668 NORMANDY WAY CUPERTINO, CA 95014-5253 (366 17 054) BAUHAUS DESIGN & CONSTRUCTION CORPORATION SAN JOSE, CA 95112 OWNER'S NAME: CRUM WILLARD L TRUSTEE & ET AL DATE ISSUED: 01/03/2017 OWNER'S PHONE: 650-946-8109 PHONE NO: (408) 440-6438 LICENSED ONT TOR' DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #715255 Contractor BAUHAUS DESIGN & CONSTRUCTION CORPORATION Date X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL _ COMMERCIAL 06/30/2017 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 JOB DESCRIPTION: license is in full force and effect. KITCHEN REMODEL (160 S.F.); BATHROOM REMODEL; HALL BATHROOM (40 S.F) MASTER BATHROOM (50 S.F.); REPLACE I hereby affirm under penalty of perjury one of the following two declarations: FURNACE - ATTIC 1. 1 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 r 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 Sq. Ft Floor Area: Valuation: $70000.00 permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 36617 054 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 18q DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertino Municipal Code, Section 9.18. �� j � j .Signature Cz c 1 r Date 11312�17 Issued by: Abby A snde Date: 01/03/2017 OWNER-BUILDER DECLARATION 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: installed without first obtaining an inspection, I agree to remove all new materials for t. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 1/3/2017 contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health i& Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous permit is issued. I s. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of I become to the Worker's Compensation of the the Health & Safety Code, Sections 25505, 25533, and 25534 exemption, subject provisions Labor Code I must forthwith comply with such provisions or this permit shall Owner or authorized agent: ) bafie be deemed revoked. - Date: 1/3/2017 APPLICANT CERTIFICATION 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 Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree 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 ARCffi DECLARATION consequence of the granting of this permit. Additionally, the applicant understands used a u I understand my plans shall be used as public records. and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 1/3/2017 • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ' CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCftupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 5i ALTERATION / Tl F- REVTSION / DFFFRRF.D ORTOTNAT. PF.RX4TT it PROJECT ADDRESS �j / �® r� .q /y a,A %n y j (i�,,uN APN # L� J� SIVA "I( OWNER NAME V,,* Cto �G4 tYY 1 sC. B /� q� PHONE STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME.3,,,,t dfif PHONE t -T 4 ®�'� ! �� E'L8Rg .40$5,4PJ7e6EdG STREET ADDRESS �l ^ I` 'CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDERI� ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT Z ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME y y(, �1WW LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTBNGINEERNAME3,1;5j_bf%f�I LICENSENUMBERryfyt'"r� �`-'� Q_j BUs.LIC# 1J 2_(„/ „ �1 COMPANY NAME s'f7/`%C/S CJ !q %gJvC�,ST�r�'.JIC�.Jri �!'�•e•Cf"AX �T�l STREET ADDRESS5 ,Z/L) / L7"°4� CITY, STATE, ZIP `t'�OSC J/ j / ® —, % �t.5® ��J (Q�f DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE 1 # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN _ REMODEL AREA �o REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH []ATTACH #DWELLING UNITS: ISASECOND UNIT E] YES SECONDSTORY ❑YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE EIVED BY: , I TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO yjqoc 0 By my signature below, I certify to each of the following: I am the property owner or authorized 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 of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t uilding cons ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent: Date: aaI 1 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE RotrrlNG SLIP p OVER THE -COUNTER: %2f 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 El FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to El MAJORSANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 'I