Loading...
B-2016-3208CITY OF CUPERTINO BUILDING PERMIT BUH DING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3208 21580 STEVENS CREEK BLVD CUPERTINO, CA 95014 (357 20 001) METCON TI, INC. PLEASANTON,CA 94566 OWNER'S NAME: KAILATH JOHN M AND ELIZABETH J TRUSTEE & ET I J DATE ISSUED: 01/17/2017 1 OWNER'S PHONE: 408-857-2541 om In I t I � ► License Class.B Lic. # 79 4978 Contractor METCON TI. INC. Date 07/31/2018 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. hereby affirm under penalty of perjury one of the following two declarations: a. I have and will maintain a certificate of consent to self -insure for Worker's IVCompensation, 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. 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 regula ' - s pert ie Cupertino Municipal Code, Section 9.18. �j Signate Date OWNER-BUI DER DECLARATION 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). [ 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. 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 NO: (925) 84614433 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: T.I.-TO CLEAR CODE CASE -FIRST FLOOR BATHROOM REMODEL (2 BATHROOMS) (260 SF) -OFFICE BUILDING Sq. Ft Floor Area: I Valuation: $10000.00 APN Number: Occupancy Type: 357 20 001 A (Tenant Improvements),B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 01/17/2017 RFS 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 ofApplicant: TO BE CLASS "A" 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 ectionss25505, 533, and 25534. Owner or authorized genet v — Date: CONSTRUCTION LENDING 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 16ECLARAT ON I understand my plans shall be used as public records. Licensed Professional March 10, 2017 City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 To whom it may concern, Due to unfortunate circumstances I need to change contractors for 21580 Stevens Creek Blvd. Restroom Renovations and ADA lot improvements. Current contractor of record is C C E Construction Permit # B-2016-3208 issued January 17, 2017. Replacement contractor will be Metcon Ti, Inc. contractor license #974976-B. Thank you for your cooperation. � - qOx- CZ j 7 - 2 5-y/ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3208 21580 STEVENS CREEK BLVD CUPERTINO, CA 95014 (357 20 001) C C E CONSTRUCTION SAN JOSE, CA 95131 OWNER'S NAME: KAILATH JOHN M AND ELIZABETH J TRUSTEE & ET DATE ISSUED: 01/17/2017 OWNER'S PHONE: 650-867-1364 PHONE NO: (408) 609-1864 LICENSED ONT A TOR' DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #956860 Contractor C C E CONSTRUCTION Date 01/31/2017 X BLDG- ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — 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: T.I.-TO CLEAR CODE CASE -FIRST FLOOR BATHROOM REMODEL I hereby affirm under penalty of perjury one of the following two declarations: (2 BATHROOMS) (260 SF) -OFFICE BUILDING 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. 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 c C permit is issued. _ Sq. Ft Floor Area: Valuation: $10000.00 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 laws relating to building construction, and hereby authorize 357 20 001 A (Tenant Improvements),B (Tenant Improvements) 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 Cupertingmaftipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur Date 1117/2017 Issued by: Kim Dunbar Date: 01/17/2017 OWNER-BUIL DER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: 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 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: 1/17 /2017 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. HAZARDOUS MATERIALS DISCLOSURE 2. 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 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, Secti 25505, 25533 Labor Code, I must forthwith comply with such provisions or this permit shall ,, -- — be deemed revoked. Owner or authorized agen . APPLICANT CERTIFICATION Date: 1/17/2017 1 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 (ON TR TION LENDING AGENCY 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 DECLARATION 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 1/17/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3256 CIJPERTINC) (408) 777-3228 FAX (408) 777-3333 • buildincL at��ertinO.Org ��}(f n `3 I 1 NRw f.omgTR i Tr.TTOV I - I AnnITInV 5 I d7 TAA.��TLlhi IT[ [T"i RA'l7TCTn1,T IT7T.G'GRDC(T1,Vbtr)7)T!`_iAT AT nu— PROJECT u— PROIECZIADDRF�SC '21 ; APN $ „ 0 1 OWNERNAME J"— J PS5 $� ^y E-MAIL P� 4411 STREET . DRF.SSS� �� CITY, ATE, Z t ^ C A FAX ^'- CONTACT NAME \ s P' 0 �is'1 / ^- /�- �, j� & AR S1T1�JFT ADDRI3 CITY, STATE, P � 4 ❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrrECT ❑ BNGINEER ❑ DEVELOPER ❑ TENANT CONTRACTQRNAME LICENSE� BUS. LIC S '®p 3 Qs• ��3 COMPANYNAME - �- IQ1"SC1V� C[ 1 FAX STREET AD ES °�C. Cc3�i CITY,S'f�TE,ZIP L �1 /H�p 1 4 �f PL" 709)§ U l �I � T7 ARCHITBar/PhIGINEER NAME LICBNSB NUMBER BUS. LIC $ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE. DESCRIPTION OF WORK EXISTIN SE PROPOSED USE CONSTR. TYPES STO USE TYPE OCC. SQ.PT. VALUATION ($j EXISTG v AREA NEW FLOOR AREA AREA T ARFA TOTAL - - :NETAREA � � I fir` �`y f_. { 1•� V Ir BATHROOM KITCHEN OTHER , REMODEL AREA REMODELAREA RFAMODBLAREA PORCH AREA DICK AREA TOTAL DECKIPORCH AREA GARAGB AREA. -DETACH ' ❑ A77ACII { I_ #DWELLING UNITS: 1SASISCON7n UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ®NO ADDITION? PNO PRF -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN j]Y TOTAL VALUATION: PLANNINGAPPLO []NO• PLANNING APPROVAL LBrTBR EICHLERHOME'? By Dry signature below, I certify to each of the following: I atn the property owner or authorized agent the property owner 1£ I have read this application and the information I have provided.s con'ect. I have read the Description of Work and vedly it is accurate. I agree to comply wi , applicable local ordinances and -state laws relating It iii n-Getion.)resent '•ves- f Cupertino to enter the above -identified pinperty for inspection purposes. �ofApplicant/Agent: / Date: Signahu47' SUPPLEMENTAL INFORMATION-QUIRED ::�' :O>:�};_;l;:-l:i-�T':_H::�-:t_.`_O;-U:rcNI'E.::R.::_:�3:-•,::::';:;_:a.:-;: a:.::':;�...•:,r::—.:-):#_-:U_: :>_I�L..-;_•.D°.: ,3=_1:.Y:::6;_::.P•-::-L__: -i_'N New SI'D or Multifamily dwellings:s: Apply for derTotionpe rifor pelmet is required prior to Issuance ofbubuilding building(s). Demohtlon ..... __ .. . permit for new building. Exrti> s" ; __::':` :>_ { - `" _:. -.::.- .pnc�vc.; G� N ip t-<::.:• v.__..:.-:': _ Commercial Bldgs: Provide a completed Hazardous Matedals'Disclosure ; `srnirtidRn runlic`)v©xxs:,.,,.-:.,..,,.;..._:„-.,...,.. form if any hazardous Materials are being used as part of this project. LARGE © k1RE➢EPT•„•= ___. Copy of Planning Approval Letter or Meeting with Planking prior to :;�; ,I�AJOA:;`-'::-".`: 5`.?�: � . > I�;i:?ANITARI' SE�VER,DISTK[CTj.S[a[:'•. submittal of Building Permit application. r?,=',:� - .. ---• ;._.: '. , -;:, _.-:: _.. ...__........ .._. �_'EIVViROA`tIENTALHEAL'1'H': `..:':. B1dgApp2011.doc revised 06121111