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B-2017-0360- CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0360 18631 RUNO CT CUPERTINO, CA 95014-3865 (375 25 024) ALLCONS GROUP INC CUPERTINO, CA 95014 OWNER'S NAME: ASHER JAMES H AND JANE A OWNER'S PHONE: 408-647-0442 LICENSED CONTRACTOR'S DECLARATION License Class Ja Lic. #9007058 Contractor ALLCONS GROUP INC Date 01/31/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. 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 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 regulationsor,*e Cupertino Municipal Code, Section 9.18. Date 3/3/2017 OWNER -BUILDER 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I 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. z. 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. s. 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 17 DATE ISSUED: 03/03/2017 PHONE NO: (408) 412-4309 BUILDING PERMIT INFO: X BLDG X ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCLAL JOB DESCRIPTION: KITCHEN REMODEL (100 S.F.); HALLWAY BATHROOM REMODEL (40 S.F.); REPLACE WINDOW (6)- LIKE FOR LIKE TO MEET EGRESS; UPGRADE PANEL (200 AMPS)- SAME LOCATION Sq. Ft Floor Area: I Valuation: $25000.00 "N Number: Occupancy Type: 375 25 024 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 03/03/2017 RE -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:. Date:/3 3/2017 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Se , 25533, and 25534. Owner or authorized agent: Date: 3/3/2017 CONSTRUCTION LENDING AGJCY 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ' (408) 777-3228 • FAX (408) 777-3333 • building--cupertino.org Cupr=RTINO i I �/ El NEW CONSTRUCTION ❑ ADDITION Id�°I ALTERATION / Ti n RF.VTCInt r / r)F.FF.uuFn nurr iMAT nr uT,arT :4 PROJECT ADDRESSV� 6 3 p ��� c4 APN # 1.e g� p CIO OWNER NAME Ali' f1 bba'5f YI4 /`"-T bba'51, PHONE j- S 6 ci7ok1q.2_ L1 l E-MAIL y�! Gt o � �J�� 5 t eJ is-;'r+�-o �.. GlR„ STREET ADDRESS IS 05 31q UnO C i V CITY, STATE, ZIP r` �i ' � ' Nqt FAX CONTACT NAME 14 Ile 97 PHONE qos �ld%/ ,3,oq (3� t E-MAIL/P�7t5.(� � y�� ^� 1�a'• c( STREET ADDRESS /6 ti q 5 1 1 c4, e y A � �j -H^ CITY, STATE, ZIP �"��� FAX ❑ OWNER 11OWNER-BUILDER❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT �/J 0 CONTRACTOR NAME/160P 5 61-00P LICENSE NUMBER i �7 rI `7 y� C LICENSE TYPE 12 !=J BUS. LIC # COMPANY NAME n ![I( ® � 6'r461� j� !( E-MAIL jl/Vt1n(S Q ©® ry / ria' / low 'tel 1"Ij i . �QM. FAX STREET ADDRESS 2 0 L166 Igo �Q 54e ,,1 d' 13^ h fT / u �C%� CITY, STATE, ZIP Cr o pe -:41"n-6) CA PHONE q6 � qJ i_4 0rq ARCHITECT/ENGINEERNAME LdIICENSENUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE � w t o •6titayc). DESCRIPTION OF WORK j� 0� _/f� &� iy ce nai r -�Cy 5 'r -k& -j-0 fil 4 e 6 lr i n doW S EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES � USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM Q� REMODELAREA (,� KITCHEN REMODELAREA\w OTHER REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: Ll DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN El YES . EICHLER HOME? ❑ NO RECE ED BY: s V YYi'' T TAL VALUATION: `r u "'— By my signature below, I certify to each of the following: I am the property owner or authorized agent to acct on the property owner's behalf. I have read this application and the information I have pr vided 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 relating to b onstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 0310311-4 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS © PLANNINGPLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. El LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to [ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONIVIENTAL HEALTH BldgApp 2011.doc revised 06121111 'k-