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B-2016-1194CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1194 10159 S FOOTHILL BLVD CUPERTINO, CA 950]4-2601 (34214117) (GENMOR PLUMBING INC) SAN JOSE, CA 95131 OWNER'S NAME: NORDEN, ARNOLD F TRUST 12/18/96 DATE ISSUED: 01/14/2016 OWNER'S PHONE: PHONE NO: T I NS .D C-ONT)RACTORIS DECLARATION BUILDING PERMIT INFO: License Class Lie. # T 3 3 % I Contractor ( GENMOR PLUMBING INC) Date '_�01 to X BLDG _ ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencingMECH 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: Replacing (11) windows and (2) french doors - like for like %hereby affirm under penalty of perjury one of the following two declarations: r. 1 have and will maintainer 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, Sq. Ft Floor Area: Valuation: $6500,00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct, i agree to comply with all city and county APN Number: Oceu an e P cy Typ : ordinances and state laws relating to building construction, and hereby 34214117 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, casts, and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City In consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -paint source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. ®' �/��• 1- % 4 &Issued Signatui a �� . Data ! by: 1�44y< Date: OWNER -BUILDER DECLARATIOTj RFRF ROOR's.S I hereby affirm that I am exempt £ram the Contractors License Law for one of the All roofs shall be inspected prior to any roofing material bring installed. If a reef is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. 1, as owner of the property, or my employees with wages as their solo inspection, compensation, will do the work, and the structure is not intended or offered for safe (See.7044, Business & Professions Cade) Signature of Applicant: 2. 1, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). %hereby affirm -under .penalty of perjury one of the-following.three.decIarations:- ALL ROOF COVERINGS TO BE CLASS "A"' OR BETTER L 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit fs issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous a. I certify that in the performance of the work for which this permit is issued, I 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 BayArea Air Quality Management District I well maintain with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, atter making this certificate of p g the Heaith &Safety Code, Sections 25505, 25533, and 25534. Health & S 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 Owner or authorized age be deemed revoked, Date; APPLICANT CERTIFl A( TION } -^11.1 ''Z O f b CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above Information is I hereby affirm that there Is a construction fending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Mame to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records, Cupertino Municipal Code, Section 9.18. Licensed Signature Date Professional CONSTRUCTION PrERMIT APPLICATION - COMPtUNITY DEVELORMEN T DEPARTWiENT . BUILDING DIVISION ts 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTiNO. (4D8) 77-3228 + FAX (408) 777-3333 + build! norgcunerino.oro D_SCJt�TEO?>s OF WOP,it r,•1 0(U0VrS-cur- E)OS'IT?IG1ISb FROPOSiM t COI,SiR 1�?8 STORTS erdina,crs and state lav s Tem lefirg'o buildin; corlstruc#ion, I authorize rte_ e. stno to enter the above.-ideati= ed property :or ias�eetl0n pt?r GSeS. 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Copy of PI2r-+ir=g Aggroval L• ever Gr I,fee#irt� wil.}1 P]a_�air-1g prior to - SL•I3rlTit#21 ofBuilding PCTf21i# i;F7p IFC2t1Gr1.S� Wiz`=-::. �:-� = £_ ��� - -- =�•�,_---��_, '_�_ �__�„..� ,: BATHWOM KDFCF�1 0 R RM,10DEL.57LA RM110DEL?.ILA I XF-140D--L UZA � 1 PORCH A -UA D➢ -M AREA TO T Q D-CK+FORMI t EA WaAGE ARP.A: DETA: I I ATi'ACH I I I TMDRELLB4GUF?ritS: 1SASEC0N1)u4Ir ©YES sECO:DSTORY 07=5 BrngG ADDED? []h0 A.DIMHON? Dh0 I4 1IRS-14DslCAT104 OYES 1FYES•PR0'M---CO2,Y0F 2 , T. ISir'.I BLDGkt� r5,_ ❑,a•C�I _ _'3 _,__.`�'{- =��= i ?�,L�ratUATiON: hR,ZT�'GAP.P.D1t,L�TcR I iTCHLER?;O?,i&! 1.0 "-__ _ ---_ s ny my mgn_wre oefow, e cun-Ty ro eacn oT ime ioffari'1ng: i am the propert , owner or autnorizec� Eees:i to arA the prope„y owner's behalf. I hai'e read this applimtion and the information I have provided is conca. I ha -•e read the Description of Z r rk �da�i: it is aces*ata. I zaree to ce nply •With ell kpplicahle 1oca1 erdina,crs and state lav s Tem lefirg'o buildin; corlstruc#ion, I authorize rte_ e. stno to enter the above.-ideati= ed property :or ias�eetl0n pt?r GSeS. Sid eture ofnr PPI icant/Agent Date: SUFPLEI 2�TAL?I�rORI �. T3IRBD-. New C - hf ,f'ir” ,mil -e: iinca• d - lve\+7 ��� 0, . iLeT..u,-F.jr d ti. eI__. ..D 1 --,-or Lie1'i7olFiiOFT I70i=1?i# IDE e - is I1ICTOII#]Qi:F # "eOUi,ef] Y�-z-�-�-�.-.�-_�-� -- :.,T:Tih,� r.' tl � v AtSt1D�i3Ui]L}•]DES. .s r � _ prior #D ._stiarlce ofbili _{) p pe., itfGrizewbtriiding. � _�_�_.-��__ —__ _ - ..�•��L�IDLtiG=PL'3;���3?y:�;t� �=„��_-; ->-. ;py _ Co._,aTerc'al BIda : Provide a rA ap]Eic[i Hazardous hla#erials DisclG re if all Hzza:&us hft-teria s: an heir -1 Lsed r2rt ` 'i• #, fA�z_ '-M Imo^_-- - `- ` _`' �'="'�•�_- u - _`' ”' - Tw r =.' 1rornn as Fs pro c#.F-:— Y g r Ge :�• - - .' Copy of PI2r-+ir=g Aggroval L• ever Gr I,fee#irt� wil.}1 P]a_�air-1g prior to - SL•I3rlTit#21 ofBuilding PCTf21i# i;F7p IFC2t1Gr1.S� Wiz`=-::. �:-� = £_ ��� - -- =�•�,_---��_, '_�_ �__�„..� ,: Blc'g � pp_201I, doc.revised 06121/11 F