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B-2017-0471CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0471 20691 FORGE WAY CUPERTINO, CA 95014-6334 (323 36 020) EDEN LANDSCAPE OWNER'S NAME: FORGE -HOMESTEAD LP OWNER'S PHONE: 408-739-0870 LICENSED CONTRACTOR'S DECLARATION License Class D-27 Lie. #709854 Contractor EDEN LANDSCAPE MANAGEMENT Date 07/31/2017 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: 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 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 vermit 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 pr the�Gupertino Municipal Code, Section 9.18. Signature Q / Date 416/2017 hereby affirm that I am exempt from the Contractor's License Law for one of the MANAGEMENT SARATOGA, CA 95070 DATE ISSUED: 04/06/2017 PHONE NO: (408) 858-9085 BUILDING PERMIT INFO: X BLDG —ELECT _PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: INSTALL ('1) CONCRETE DECK AROUND (E) SW AMING POOL; SHOW BONDING LOCATIONS Sq. Ft Floor Area: Valuation: $90000.00 APN Number: Occupancy Type: 323 36 020 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: 04/06/2017 ving two reasons: All roots shall be inspected prior to any rooting material being installed. If a roof is i. 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) 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. 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 waking 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 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 4/6/2017 Signature of Al Date: 4/6/2017 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety de, Secljons 25505, 25533, av d 25534. Owner or authorized agents.%r.� / Date: 4/6/2017 CONSTRUCTION LENDING AGENCY 1 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 L21 n NT.W CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 05014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin cuoertino.©rg, n ADDITION n .ALTE;RATION / TI I REVISION 7 DETERRED ORIGINAL PERMIT ` PROJECT ADDRESSp f � � O 1 .00 APN t� rj �J f /� �0 ,J l� V OWNERNAME Ii NE E-MAIIj �-Ii12 s��.�Itas _0aa-t.w'� —_ ..... - 3'Z R-' 0 $�1D—rt�lrrorwP "�� ,4�too �e STREET ADDRESSjf r-t"4jie �n CITY, STATE, ZIP �p t IS-0170 CONTACT NAME04,j tai . r J C� PH ©if O S O �" E-MAE��$(t �7Yt qOS��Wi pJ►p0. �- STREET ADDRESS nh 65-S-p s CITY, STA'PE, ZIP ,. + Q 1 FAX 12 ,e ❑ OWNER ❑ OWW.R-BUILDER El OWNER AGENT IIdCONTRACTOR ❑ CONTRACTOR AGENT 11 ARCI41TECT ❑ ENGINEER ❑ DEVELOPER D TP,NANT CONTRACTOR NAME —10 H'J h LICENSEUMEER LICENSE TYPE 17 o la EUS. LIC # L'OMPANYNAME�^1 E-MAILS i�A /�^vF{ 7� FAX ( AM i*.veO STREETADDRESS i 2 / sG`M•++ tt 3 P�- .es f C1TY,STATQEIZIP s ,�. 9S -D'70 � ARCHI'T11CTIENGINEERNAME LIC - SENUMBER BUS, LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE - -DESCRIPTIO -61? WORK-"___ �.O+SCt?_S�C t4 '�✓r C1 LIN^f�� 1 r�xUJkli1 /'h / /i ti t� 1STM USE PROPOSED USE CONSTR. TYPE # STORIES USB TYPE OCG, SQ.FT. VALUATION ($) El1STO NEW FLOOR y - ^ – DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECKAItEA — TOTAL DECKIPORCH AREA GARAGE AREA: EIDETACH ATrACIr — #DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? ❑ NO ADDITION? ONO ' PRTA-PPLICATION Q•YES IFYES,PROVIDE COPY OF PLANNINGADPL# []NO PLANNING APPROVAL LEITER ISTHEBLDC []YE EICHLER MET -- _ _ - _ - -_ _'. TOTAL VALUATION,', - -- - - - c,.v��© (J sV'rill _ l - By my signature below, I certify to each of the following: I am the pr owner or authorized a el taactarr#Ir operty owner's be a ve read this al)plication and the information I have provided is correct, I have read the Description of Work and verify it is accur�te. I agree to comply with all apl ieahle local d state laws relating to b ul struction. I authoriz 'epresentatives of Cupertino to enter the above -identified roperty for inspection proposes. ordinances anon Signature of Applicant7Agenl: c Date: _ )1 1 SUPPLEMF.NT'AL INFORMATION REQUIRED -:. >:.::::.:.:::: :_:_::__: Pi;Aig CHECI{ T:YPE:i-",_;:::_;:.:, ...._ ...._...,-.......:.,..: TIN .;..::;'_ :: ;::= -ROUTING SLIP:., .. _ _ .. ..... .......... - =:'Ot::.BUTLDII�GPLe�.I!> DaIM • 't for Multifamily dwellings: s: A i 1 for demolition permit er SF Y �. Apply moli 'on ermit is required prior to Issuance of builder exlsttngbulldlllg{s). I?c h p 1 p g .01'F,k2-THTyCQUNTER�:?;�[:::�::` s`= :if`_i'{q:_;.:._.;:;:_.:.: _::::::':::..•_�:.-_ :..:�..::,.:,...., ::-:............. ;;�:::::::.::.::::::::-::_:�; permit for new building. 0: i i�Ri ss; _°_: i_ : _ -_ °__:-_. -[J PLM] NINO PO: N-xsy l W: B s: Provide a feted Hazardous -ardour Materials Disclosure Idg completed 0:_arAT%!DA {n ° ; :::<;:-' -'±- `Commercial form if any Iazardous Materials are being used as part of this project. • ....`.°- -.:O.LARGE...,'.:.�. ::.. .'::-...::.. :�'.,FIRD_➢I;PT::�:a`::�cr:�{[c.:r.:�.::::._.:'.'":,: Copy. of Planning Approval Letter or Meeting with Planning prior to i:D '.SANITARY.SENVERDISTRiC'r:;::'.::c: submittal of Building Pennit application. --- _.....-_ENYIRONM1iENTALIIEA r ...... BldgApp 2011. dao revised 06127111