B-2017-0319I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0319
10304 VISTA DRAPT A CUPERTINO, CA (316 33 123) PATRICK ROSS CONST
SAN JOSE, CA 95136
OWNER'S NAME: LUCAS PAUL W AND VALERIE A TRUSTEE I DATE ISSUED: 02/28/2017
OWNER'S PHONE: 408-914-1716,' PHONE NO: (408) 226-1187
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic. #801895
Contractor PATRICK ROSS CONST Date 09/30/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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 regulation per the C ertino Municipal Code, Section 9.18.
fj
Signature Date 02/28/2017
X BLDG X ELECT _ PLUMB
_ MECH X RESIDENTIAL, _ COMMERCIAL
JOB DESCRIPTION:
REMODEL KITCHEN (100 SF) AND (2) BATHROOMS (75 SF);
REPLACE WINDOWS/ (2) SLIDERS (7) LIKE FOR LIKE; (N) SUB -
PANEL (100 AMP)
Sq. Ft Floor Area: I Valuation: $120000.00
APN Number: Occupancy Type:
31633 123
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: 02/28/2017
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 ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 02/28/2017
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 02/28/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 ma' in compIi ce with the Cupertino Municipal Code, Chapter 9.12 and
h e I Safety Code, Sections 25505, 25533, and 25534.
O er or authorized agent:
ate: 02/28/2017
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 DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
A
CUPERTQ� 0
0 NE -W CONSTRUCTION
CONStRUtT[C)NI PERMIT APPLICAT[ON
COMMUNITY DFVELOPI\/1ENT DEPARTMIENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO. CA 950'14-3255 B
(408) 777-3228 - FAX (408) 777-3333 - buildingO)cupertino.ora
201
AM)ITM-NT COAT77��,,-i,T,Tl-rl, F7 nr, ter---
UIU01-NAL PhKIV11T
PROJECTADDU 33 16 - C4 (//--S -
0
PH
"'Ey'C13- e --TY. STATE ZIP FAX
r-7 All
CONTACT N.A-bE, PHONE I E-KAIL
STREET ADDRESS
CITY, STATE, ZIP FAX
❑ OW ER ❑ OVn\-=7,-B-UT-DER ❑ WANTERAGENT kCOX-TRACTORCONTRACTORAGEN'T 0 ARCHITIECT ❑ ENGNMM 13 DEVELOPER ❑ -�--trXA-\7
CON,TKF
I*r le,:,S S- SE T-11PE
S
B
CO3,QT. Ejg/e
STY/TP,A? A"?261 TATE, ZI
CITYP
N,
I,0—clill�
—
6- 6
.A-RCHITEC- N NEEERNN". LICENSENT-T.KBER
BUS. LIC 41
COMMANY NAME
STREETADDRFSS
STATE, ZIP
PHO\T
DF-SCP,IPTIO!iOFI�70RKJ(:�l-TWeX_j
ANO U PY-4 ce-
-----------
EXISTING USE PROPOSED USE 7---,,
CON STP- TYPE s STORES
I
USE
I 'nPF-
I OCC.
SQ.FT.
VALUATION (S)
EXISTG
NPwFLOOR
DEMO
TOTAL
AREA ,
AREA
AREA
I
1, 1-7 AREA
BATHRoohl
KITCHEN
OTHER
F-EiIAODELAREA
RHIMODELAREA
REMODELAREA
PORCHAREA DECK APEA
TOTALDECICIPORCH.SRF-�,
GARAGE AREA: El DETACH
I
E) ATTACH
DIATLLJICG UNTTS:
ISA SECOND UNIT EIYES SECOND STORY E]: �S
BELNG.-A-DDED? E] NO I ADDITION? ❑N0
PF-E,UPLICATIDN -1YFS IF YES, PROVIDE COPY OF IS THE BLDG .kN I-] YES
PLANKING -Ax
PPL XO NGAPPRO-,,AL, LETTER EICHLERBOME? El NO
P ..., �,J� TQTAL VALI�.ATICN:
/40
By Iny signature below, I certify to each of the fallowing: I am the property ov,,ner or authorized agent to act on the property Der's btIalf. I have read this
application and the info orationI h Ided is geL-- t. I have read the Description of Work and verify it is accurate. I agree to comply ivith all applicable local
'a" " "
.WIre relating 7
ordinances and state ]a ction. I authorize representatives of Cupertino to -enter the above -identified property for inspection proposes.
1A
Signature ofApplicant/Agent: Date:
SUPPLEi\ \TTAL INTOR-MATION REQU'=D
PDN K
CHECTYPE ilil -,57t.
. ....
LN
A--
New SFD or Multifamily &-vellings: Apply for demolition pcniiit for
existina building(s). Demolition permit is required prior to issuance ofbuildina
:=,.>'..=:•;_:':»
.)kTjp�-CO
5
p(--i-Init Tor new building
A -N
CdoL LerialsDisclo ommercial Bldgs: Provide a complet d Haza.-isMat sur
Y
form if any Hazardous -Nalaterials are b, -in.- used as part oftaiis project.j
X.
K
Copy ofPlanning Approval Letter orIvileetin.- with Planning prior to
submittal of Building Permit application.
P
BIdgApp-.2011.doc 7-e7-1:Sed 06121/11