B-2017-01193
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10297 VISTA KNOLL 13LVD CUPERTINO, CA 95014-1033 (326 13 124)
CONTRACTOR:
GLADIATOR REPIPE
PERMIT NO: B-2017-0119
INC
SAN JOSE, CA 95136
OWNER'S NAME: WESTWOOD GORDON C TRUSTEE & ET AL
DAA
ISSUED: 01/23/2017
OWNER'S PHONE: 408-396-6121
PHONE
NO: (408) 444-2696
LICENSED CONTRACTOR'S'DECLARATION
BUILDING PERMIT INFO:
License Class C$6 Lia #1008291
Contractor GLADIATOR REPIPE INC Date 1013IM17
X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— 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:
COOPER RE-PrPE SFD (2 ,0
5 S.F.)
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
of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
f�-performance
Section 3700 of the Labor Cade, for the performance of the work for which this
permitis issued.
Sq. Ft Floor Area:
Valuation:
$6000.00
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:
Occup�ncy
Type:
and state laws relating to building construction, and hereby authorize
326 13 124
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agre ave indemnify and keep harmless the
City of Cupertino against liabilities, Jud ents, costs, and expenses which
may accrue against said ty in consequ6 ce of the granting of this permit.
PERMIT EXPIRES '11F WORK IS NOT STARTED
,p
Additionally, the ap icaVit understands an will comply with all non -point
source regula on peCthe Cupertino Muni ipal Code, Section 9.98.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CAL PECTION.
Signature % Date 09/23/2017
Issued by: MELI
Date: Q1123120I7
I hereby affirm t t la from the Contractor's License Law for one of the
following two ren o s:
1 RE, ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as o r 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 (See.7044, Business & Professions Code).
Date: 01/23/2017
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. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 1 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 Qualima ement District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with th? Cu _i - nieipal Code, Ater 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code gfions 25505, 25533, and 2 534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agen r' i
APPLICANT CERTIFICATION
Date: 09/23/2017
I certify that I have read this application and state that the above information is
CONS
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a constr tion lending agency for the performance
of work's for which this permit is 1 s d (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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 1
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
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 01/23/2017
Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 buildinaCq)cupertino.or
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USE OF 0STD.,DUPLEX MULTI-FAXIILY PROJECT IN WILDLAND l YES
PROJECT IN 07mIS
THE BLDG AN rl YES
DING: F1 CON24ERCIAL
TJRBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ _"O
EICHLERHOME? ❑ ANo
DESCRIPTION OF WORK
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TOTAL VALUATION: 00e)
By my Signature below, I certify to eac
eac
of
o -I "ow t1-i7M-th'6W0pe, owner or authorized agent to act on the property owner's behalf. I have read this
ha" pro-, 1
I v pro
a d, correct I have read theignaf_Wiark and
application and the information I 1��
verify it is accurate. 14gree to comply with all applicable local
ordinances and state laws relatingt
t;
i.g construction. I au�,h. represen ives of Cup��to
enter the above -identified property for mispectionpurposes.
Signature ofApplicant/A.aent:
Date:
Y -E ATIOIN, REQUIRED
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1-01-T99S OtOIAM FRbM
smoKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COmMUNITY 6F-VELOPMENT DEPARTMENT -BUILDING DRnsioN
10300 TORRE AVENUE - (':UF15RTINO, CA 05014-3256
(408) 777-3228 - FAX tot 777-39S3 -
PURPOSE
This affidavit is a self- certificatiort for
inspectiom are required.
lof 4
access fax
GENERAL INFORMATIPNT
Egi4,�ng single-fan-uly and multi -fa Lily dwellings shall be provided witli Smoke Alarms and Carbort
Monoxide ala s. 'When the valuation of addition s, alterations, <)r repairs to existing dwelling units e,'
Monoxide,
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bming appliances and that
do no I t-haveanattached.garage. Carbon monoxide alarms combined with smoke alarms shall cornply with
CBC Section 420.6 and shall be approved by the, office of the State Fire Marshal.
power Supply. In dwelling units with no commercial power $uPP1Y, alarm(s) may be solely battery Operate&
Ja existing dwelling units, alarms are permitted to be solely batterY oPelateli whete'rePa"'r or alterations do
not result iA the removal Lif wall and ceiling finishes, or there is no access by means of attic, basement or craw,
CBCSecti0TM.9-07-2J1.4-=d- 420-6a, �O
alarms which mvst be connected to -the buMing wiring.
As owner of the Above -referenced -pjoperty, I hereby certify that the ajam(s) referenced above -has/have been
imtaned in accordance with the manufacturer's instructiorts, and in compliam,-� %ith the California Building
an I d California Residential Codes. The almms specified below have been tested and are ,operational, as of the
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date sized below.
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77-4- AL -1 - , - t/.0 tS77A10 Permit No.-�F-
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SpMdY Nulilber of Alarnw. I -#.S mokeAlatm 9- 1 - WZ L #-Carbon
d2io f ih! fate t
't have read and,aaree lb WMP11A6 �eterftancf= nso -!�-s mon.
rtf.racw Name;
Smok,- and furrrr. oc ravisetl 09!27116
SM40KE ALARM
co AIRM
Oultside of eachsepaz&te sleeper area in the irmediate vicinity of
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011 basement-
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Witbineadi6q,lee room
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Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bming appliances and that
do no I t-haveanattached.garage. Carbon monoxide alarms combined with smoke alarms shall cornply with
CBC Section 420.6 and shall be approved by the, office of the State Fire Marshal.
power Supply. In dwelling units with no commercial power $uPP1Y, alarm(s) may be solely battery Operate&
Ja existing dwelling units, alarms are permitted to be solely batterY oPelateli whete'rePa"'r or alterations do
not result iA the removal Lif wall and ceiling finishes, or there is no access by means of attic, basement or craw,
CBCSecti0TM.9-07-2J1.4-=d- 420-6a, �O
alarms which mvst be connected to -the buMing wiring.
As owner of the Above -referenced -pjoperty, I hereby certify that the ajam(s) referenced above -has/have been
imtaned in accordance with the manufacturer's instructiorts, and in compliam,-� %ith the California Building
an I d California Residential Codes. The almms specified below have been tested and are ,operational, as of the
W
F2//S��
date sized below.
, / - 2e- '0 "
77-4- AL -1 - , - t/.0 tS77A10 Permit No.-�F-
/4 Zc
SpMdY Nulilber of Alarnw. I -#.S mokeAlatm 9- 1 - WZ L #-Carbon
d2io f ih! fate t
't have read and,aaree lb WMP11A6 �eterftancf= nso -!�-s mon.
rtf.racw Name;
Smok,- and furrrr. oc ravisetl 09!27116