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B-2017-0051 CITY OF CUPERTINO BUILDING PE' I T BUILDING ADDRESS: CONTRACTOR: P:RMIT NO:B-2017-0051 7549 NEWCASTLE DR CUPERTINO,CA 95014-5220(366 17 072) AR S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS,TN 38120 OWNER'S NAME: TAMMARO PAUL JAND ARLENE N TRUSTEE D•TE ISSUED:01/09/2017 OWNER'S PHONE:408-257-5070 P•ONE NO:(901)271-9700 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT I I 0: License Class GENERAL ENGINEERING CONTRACTOR Lic.#765155 Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG _ELECT X 'LUMB Date 07/31/2018 _MECH X RESIDENT AL_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 JOB DESCRIPTION: license is in full force and effect. TWO WAY FOUNDATIO CLEAN OUT 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 0;....„. 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 Sq.Ft Floor Area: V nation:$3100.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: 0 cupancy Type: information is correct.I agree to comply with all city and county ordinances 36617 072 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 EXP 'I S IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 D YS 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 FRO I LAST CALLED INSPECTION. source r ulations per the Cupertino Municipal �Code,Section 9.18. Issued by:Abby Ayende Signature Date 1/9/2017 Date:01/09/2017 r„/ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first ob.•.• g an inspection,I agree to remove all new materials for 1. 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:1/9/2017 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF CO RINGS 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 HAZARD•US 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&Sal:ty 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 he Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,S•ction 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,sho Id 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 define, by the Bay Area Air Quality Management District I will maintain compliance :ith the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Saf;ty Cod ,Sections 25505,25533,and 25534. 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 Owner or authorized age t: be deemed revoked. `- Date:1/9/2017 APPLICANT CERTIFICATION CONS Ii'UCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there i-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 per it 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 consequence of the granting of this permit. Additionally,the applicant understands a_t i :I ._t_: Y . and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans sha I be used as public records. Code,Section 9.18. Licensed 16-7.0\R-- 005 C 4,16./ GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION J, 10300 TORRE AVENUE..CUPERTINO,CA 95014-3255 GIfPFt C`tNC3 (408)777-3228•FAX(408)777-3333•buildinQ(a-cupertino.orq M I S C El PLUMBING ❑MECHANICAL ❑ELECTRICAL El MISCELLANEOUS PROJECT ADDRESSjJ(�Cd e.• C�94 te 0 y AP"# (_ 1 09-2_ OWNER NAME () PHONE ` E-MAIL STREET ADDRESS ICT CaS� ,9 CITY STATE;fid 0 g Sti FAX FAX Li CONTACT NAM . , f [PPHfie ONE rn E-MA STREET ADDRESS �0 5' P�� -vv Y CITY,STATE, �6, ,ZIP `ry r+ 3; FAX '4 ID OWNER CIOWNER-BUILDER 1:1 OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCmTEC' (❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEy� LICENSE NUMBER LICENSE TYPE BUS.LIC# eliAk !x-.30 '--) ( 11 Sr'S' 0 776 C-Ui,2 'Z( ,S—CY-J COMPANY NAM dr CA-- S 9 A Y EMAIL Ve n S l rc"q FAX STREET ADDRESS �"`� CITY,STAT IP , PHONE 25c) Vo, rte,! (t)lc 4 C17311 cc-9 t7 -OLIO -- II ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP • PHONE USE OF WE'D or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN YES IS THE BLDG AN ❑ YES BUILDING:, El COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD.ZONE a NO EICFILERHOME? 0 NO DESCRIPTION OF WORK -1-1-1/4D DU Oan__0,1_o__ _1.7 TOTAL VALUATION: <.....m..,72 / C F.y RECEIVED BY: } . p 1 J El : 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 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 relatint to building co u:• ctlo I authorize representativ- Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 1 1 q..f i SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY D OVER-THE-COUNTER ' 0. EXPRESS u 0 STANDARD ' U D LARGE 0 MAJOR - MEPMiscApp 2011.doc revised 06/21/11