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B-2017-0362I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: 19479 ROSEMARIE PL APT 4 CUPERTINO, CA 95014-3452 (375 01 007) HOMEOWNER OWNER'S NAME: COHEN DAVID N AND WEISS CONSTANCE U ET AL OWNER'S PHONE: 650-766-9160 LICENSED ONTR TOR' ARATION License Class Lic. # Contractor HOMEOWNER BUILDER Date 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: r. 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 regulations per the Cupertino Municipal Code, Section 9.18. Date 17 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 ompensation, will do the work, and the structure is not intended or offered for Ris, ale (Sec.7044, Business & Professions Code) L 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. 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. 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 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 gran ' g of this permit. Additionally, the applicant understands and will comply with all n -point source regulations per the Cupertino Municipal Code, Section 9.18. / Signature Date 3/6/2017 NO: B-2017-0362 ISSUED: 03/06/2017 PHONE NO: BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: UNIT 4 - BATHROOM REMODEL (100 S.F.); KITCHEN REMODEL (100 S.F.) Sq. Ft Floor Area: I Valuation: $20000.00 "N Number: Occupancy Type: 375 01 007 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION, by: Abby A, eY nde 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 of Applicant: Date:/3 6/2017 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 Cuper Municipal Code, Chapter 9.12 and the Health & Safety Code, Sec ' s 25505, 25533, and 25534. Owner or authorized agent: Date: 3/6/2017 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 DECLARATION I understand my plans shall be used as public records. Licensed Professional COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building(d)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION Q ALTERATION/ Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 19479 Rosemarie Pi, #` 4 Cupertino, CA 375-01-007 7# OWNERNAMECohen David N et al PHONE 650-766-9160 EMAILdc94086@comcast.net STREETADDRESS460 Fairfax Ave. CITY, STATE, ZIP San Mateo, CA 94402 FAX CONTACT NAME Robert Moore PHONE 408-824-1116 E-MAIL robert@fosnessgroup.com STREET ADDRESS3131 S Bascom Ave., #230 CITY, STATE, ZIP Campbell, CA 95008 FAX ❑ OWNER ❑ OWNER -BUILDER H OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Tim Heath LICENSE NUMBER 863821 LICENSE TYPE Elect BUS. LIC# COMPANYNAME Star Lighting & Electric EMAILheath833@gmail.com FAX STREET ADDRESS 3860 Oakes Dr. CITY, STATE, ZIP Hayward, CA 94542 PHONE (650) 787-7250 .ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Bathrooms & Kitchens: Remove and replace existing cabinets, plumbing and electrical fixtures, and tile, like -for -like. Under Contractor Star Lighting & Electric: Upgrade kitchen electrical to current code. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES " BEING ADDED? []NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REOEIVEDBY - - -- TO -, VATS 'd" PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? E] NO 1 1 to, V By my signature below, I certify to each of the fol ing: I am the property owner or authorized agent t act on tle property owner's behalf. I have read this application and the information I have provid s 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 buildin construction. I authorize representatives of Cupertino to enter the abe-i e of d property for inspection purposes. Signature Applicant/Agent: Date: of 1 SUPPLE TAL INFORMATION UIRED rLA7v LICK TYPE, . >zau rIIvG SLIP-' fl� CoiJNTE12 [ # 0ING pyA :REVIE W _ 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. ❑ t)WRESS EVIEW. l� PLANNING PLAN REVIEW.- Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Commercial n STANDARD I—1 )PUBLICWORICS form if any Hazardous Materials are being used as part of this project. Q LARGE. El niiii _ Copy of Planning Approval Letter or Meeting with Planning prior to for sANs�rxYs> RxTRTC submittal of Building Permit application. C] I NVJR0NNJENTA J3JEALTik BldgApp_2011.doc revised 06/21/11 OWNER -BUILDER DISCLOSURE FORM COMMUNITY OeVELOPINIENT DEEPARTmENT - BUILDING JAV00N 10300 TOR E A*VENN E CUPER111NO, cA u4 3265' (4 08) 777-327-8 - FAX (408- 7777-=3 - buildingta Dear Ptoporty Owner(s): An ah ppli6atio for a building permit has been submitted if, Your name listing, you builder rsWas the Wilde of -the property improvements:s pecif ted at: . SrrE ADDRESS�0 19479 Rosemarie P!, Cupertino, GA 950141 Ap' ' 375-01 ' 07 as �-ft2 OWNER DAME C P OWNER ADDRESP ..ohent)avid N; Cohen TheIrna 460 Faiffax Ave., San M teo,,CA 94402 .. ... . .... DESCRIPTION OF WORK: Kitchen renovations and electrical panef.upqrodes on all 4 units, of our 4-plex. We are providing you with an Owner -wilder Acknowledgment and information VerlfiCaf;mak awto m For n e you are of 1,0 your responsibilities and possible ri k y0 umay, incur by having thispermft issued r, yownam e as the Owner -Builder. We willsildt issue a building perrnit until you hove read, initialed your understanding of each grovislon, -sighed, and retufnedthis fbrM710 us at dur official address indicated. An agent of the owner canno f execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. RECTIONS., Please read Arad initial each statement below.40signify- you understand.or verify this'ihfbrmadon.� I understand a frequent pro ct tee of zi . licensed persons is to have -the propefty owne r obtain ; anOwner- Builder" building.permit that erroneously implies that the property.owner is providing his, or her own labor and nate f mater personally. 1, as an Owner -Builder, ma y be held liable and subject to serious financial risk for any injuries sust i ed by an unlicensed person brid his or her employees whilewo W rking on my property. My homeownets insurance may not provide c ;;erage.for those injuries, larn vviflfully acting as an Owner -Builder and alt, aware of the limits of MY insurance coverage for injuries to workers onm.y properly, y, 'Y17 2 1 u riderstand tyuildirig permits are. not required to be signed by property w ers uril s- ey are res po o n a s th eq nsible for Fhrconstruction__* And are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an 'Owner-B.ullder" I ant the responsible party of record on the'permft. [-understand that I may p06`ct Myself ffom Pofential financial risk by hiring a licensed Contractor and having the permit filed in his or het- name ername irittead of My; own, -4-1 understand Contractors are required by law to be licensed and bond 'd to list ed in California an L their license numbers on permits and contracts, t toy or btherwriise engage ,any persons -other Calitomia. lice tracto s, and 4 e f understand if I emp, than n8;ed Con' r ffi total V8166 of my construction is at least five hundred dollars ($500) ln6luding labor and Materials; I may be considered an "employee under state and federal law. %f A understand if 1 am considered an .'employee' under state andfa-deml lave, 1 must register with the state and thhold pa federal oovernmentvA yroll taxes, provide workers' compensation disability insurance, and contribute to unemployment c6m'PeWation for each "employee," 1 alsio understand my failure to abide by these laws inay-subject. rise to serious financial. risk. �,-V'7 I understand under California Contractors' State License Law,an Owner-l�uifdler who builds single-family rAte-e 'tial structures cannot fegalty bufli d there with the intent to offer thern for sale, unless at! work is performed by licensed subcontractors and the number of structures does not- exteedtfour within any calend&year, or At of thework is performed under contract livith a licensed general building Contractor, �,&­t -understand as an Owner -Build -r if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result frorn any latent cnnstruction defects in the workmanship or materials. 01 (1 (Im revived 04/14/16 I understand I may obtain More information.reqarding my as an"employer obligations Revenue Srryice, the United States Small Business Administr fi , yer"from the Internal ation, the California Department of Benefit Payments, and the California Dwision of Ind [us -trial Accidents. 1 also understand I may contact the California Co I ntractors' State License Board,(C-8LB; at 1-800,12l�CSLB 0752) or %ww,csIb.ca,gov far more in formation About licensed contractors. I a.ni. aware of and consent to an Owner -Builder building pen` it applied, for in my name, and understandthat I am the party legally and financially resoonsible for propbsed -0"stfucbrOn W-Fivil-V at the site address fisted above. a the gi&ee-that, the legally and financially responsible for this proposed constrtiction-attivitY, I Will abide applicable laws and requirements that govern wnor-Builders as well as emp! oyers. L -F -C -4-2'-F agree to notify the issuer of this for immediately of any additions, deletions, or changes to any of the information I have provided an :his form. Licensed contractors ate regulated by laws designed4b protect the public- If you contra.f.t With snmeone, who does hot ha v*6 a license, the Contractors' , State Lic—�irvs 0 B06rd r be unable to assist You with any financial loss You may sustain as: a result.opi of a cmf int Yo da a Or Only i6medy agains! unlicensed Contractors may be in civil court. It is also -important foryou to u in nderstmd that ifanunlicermed, contractor or employee of thatindividualor firm is Injured while workiqg on your pmpefty, you maybe held liable for -damages, if you obtain a permit as Ownef-Builder and wish to hire Contractors, you will be responsible for verifying ufhethp or not those Contractors are property licensed and the status oftheir workers GoMpensation insurance coverage. CONSTRUCTION- LENDING AGENCY 9 construction lending agency infionnatio, I hereby affirm that there Is a construction lending agency£cr the performance -of the work for Which this permit is lashed (Sac 30917 Civ.) Is Lender Name, . . .... Lender Address: Fleforda building:Pers itimn bei d,this forrri - Jb4c mul§ ompleted ailsigned bytho property owned and returned to the agency responsible for issuing the it. lNoted: A copy of the poperty owner drivers license,.. form otart za nH6 P? rmr.. r'zl, - I n, or other vetifidation acqqPt�pK?JP thoo may be raquired to be presented whan the pernift is Wued . I Property Owners Sfbnature: Date- VVLJIc.- I 'flu fullOW-Ing �WIWMKIQr -PrM Is Peqtilred to be co mpletE agent of the pr6pa* owner to apply for a constfaction permit fres the Excluding the Notice to Property Owner, the eyecut' n of which I understand: is my personal reSP .!o onal onsibility. I hereby authorize the follmWing person(s) to act as my agent(s)jb.-appiv for sign, an.,,, Ale the documents necessary to, oUtain an, Owner -Builder Permit for My project. Scope off construction Project, �Or Description Of Work): Kitchen renovations and electrical panel upgrades. Project Location or Address:19479 Rosemarie Pl-, Cupertino, GA 95014 Name of Alithohzed Agent,. Robert V Moore Tel N6-408--824-1-116 ress of Authorized Agent: 131 Bascom Ave., #230 , Campbe 1, CA 95008 Add I dec*6 under penaltyof perjury that I am the property wner for the address as t&d above and I personally filled out the above information and certify its ac racy. Note- A copy the pr p Cu o qq.y owner�� driver"s 17cense, form notadzation, or other verification acceptable to the cifyft�6y be rgq't �W- uIrvo pfeSel#eO w0en the permit is Issued to verify the property o�w7er's signature - A' "-k V_ Property Owner's Signature.' ,..... Date: / revised