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B-2016-2484CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13-2016-2484 20230 STEVENS CREEKBLVD CUPERTINO, CA 95014-2210 (369 02 031) DPI/ CONSTRUCTION A GENERAL PARTNERSHIP' REDWOOD CITY, CA 94063 I OWNER'S NAME: TORRE AVENUE PROPERTIfis I IIDATE ISSUED, 08/10/2016 OWNER'S PHONE: 650-426-1100 PHONE NO: (650) 474-1450 License Class B Lie. #95_ 3749 Contractor DER- CONSTRUCTION A GENERAL -PARTNERSHIP Date 10/31/2016 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7400) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: x. 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. z. 1 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 regulations pakthe Cupertino Municipal Code, Section 9.18. Signature i Date 08110/2018 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: s. 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sce.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations; r. 1 have and will maintain a Certificate of Consent to self-insuro 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, z. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for lire 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 ofthe Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 0811D12016 PERMIT INFO: BLDG —ELECT _PLUMB MECH _ RESIDENTIAL COMMERCIAL JOB DESCRIPTION: T.I. PREP (B-2016-2469 RM 152152A IST FLR) - 300S.F. Sq. Ft Floor Area: evaluation: $15000.00 APN Number; Occupancy Type: 369 02 031 1 B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM FAST CALLED INSPECTION; sued by: MELI .eA. 1152r1011014 BE -110Q S; All roofs shall be inspectedprior to any roofing material being installed. If aroof is installed without fast obtaining an inspection, I agree to remove all new materials for inspection. Signature ofApplicant: Date: 08/10/2016 ALL ROOF COV MI ZINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Catifornia 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 Code ec ions 25505, 2 533, and 25534. Owner or authorized agent: Date: 08/10/2016 CONSTRUCTION LE I hereby affirm that there is a construction len ng agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records, Licensed CUPERTINO- CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, GA 95014-3255 (408) 777-3228 , FAX (408) 777-3333 • buildingQcupertino.org /3 ol(I {� � ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION 1 DEFERRED ORIGINAL PE B1dgt4pp_2011.doc revised 06121111 RMIT # PROJECT ADDRESS �S ' 1 APN J`�3 OWNER NAME. i `,y P.. :•�J PHONE t ��. -)^� . 9 �� EMAIL S'!"REETADDRESS CITY, STATE, ZIP � �1 FAX '. a � CONTACT NAME PHONE j� a 54 i E.MAIII _l4a i ' STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER Cl OWNER -BUILDER OWNERAGENT ❑ CONTRACTOR ❑ CONrRACTORAGENT ❑ ARcErrr T ❑ ENGINEER 11 DEVELOPER © TEMAN7 CONTRACTOR NAME; — LICENSE NUMBER [ ; J t 6 � f —1 LICENSE TYPE BUS. LIC 4 Q)30-7— 0-7—COMPANY COMPANY NAME �� E-MAIL FAX STREET ADDRESS 1/ �} CITY, STATE, zip cA 9.5 `,•J PHONE ARCHITECT/ENGINEERRNCAAME LICENSE NUMBER - BUS. LIC# COMPANY NAME/ j, E-MAIL PY1, I o-, PAX STREET ADDKESS L� 5 / 1 CITY, STATE, ZIP ��� C SA � PHONE I C r} G G -5:37C F:1 L-- t DESCRIPTION OF WORK �( �+ /°� i # .- __`_...�' + • ' _C, ��Yl'��' GH c \gs t RY9 C'I � 1,4g 67 - 1 D T IJV EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. 3Q.FT. VALUATION ($) EXISTG ARRA NEW FLOOR DEMO AREA AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REM ODELAKA t'^a REMODEL AREA REMODELAREA PORCHAREA DECKAREA TOTALDECKNORCH AREA GARAGE AREA; ❑DETACH 0 ® ® © ATTACH I 9DI T10,11\110 UNITS: IS A SECOND UNIT .❑ YES BEING ADDED? o SECOND STORY ❑ YES ADDrr10N? 04NO 'AqI PRE-APPLICATIONYES IF YES, PROVIDE COPY OF PLAAMiNG APPL # NO PLANNING APPROVAL LETTER IS THE BLDG AN' �YFS RICHLER IOMTE �I N _ =E - --- - -- _- �•; TOTAL VALUATION: —77 By my signature below, I certify to each of the following: I.am the property o au orized 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 1Vork and verify it is accurate. I agree to comply.with all applicable local ordinances and state laws relatin o uildingc nstruction. I authorize representatives of Cupertino to enter the abf ve-ideentified property for inspection purposes. Signature of Applicant(Agent: Date: SUPPLEMENTAL TNF RMATI0N REQUIRED - - - -- Ol ER TIIk COULTER _ -- --- - - ❑ BUYLDILG PLAN REI YEA New SFDorMuttifai1 dwellings: s: Aplfor demolition permit existing building(s). Demolition permit is required prior to issuance. of building _ pmilitfornewbuildtn - Commercial Bldgs: s. P oideacooplcted Hazardous Materials Disclosure.osure_` - ❑>"':. ;� *.._ _,.' `- ":.v�-= .�i�',-r��'- _. srnLDg►tp,, _ _..,, ..: . .... .......... ��C7"°` `'< - _ . _PUISLIc S;ORiCs,=:__;.:=:; � ,�•=` ;: folzn if any Hazardous Materials are being used aspart of this project. -=D '�.�i�:: <`::;:::�;:�� '�_ _ _���. l]:r ��iiE nim ' _;,-;�`� -- :: r° := -';:<= ::• GoPY of Planning Approval or Meeho-o with Planningin gPrior t0 bmittal of Building Pemut application. - ......1JOR- .z-- : =:%--- - -- - -_;::...•- I-CT_.;_=_ A'TA- Y Sl 15 ER DI -S- TR- B1dgt4pp_2011.doc revised 06121111