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B-2017-0561CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0561 10466 BYRNE AVE CUPERTINO, CA 95014-2846 (357 14 052) BROTHERS HOME IMPROVEMENT INC ROCKLIN, CA 95765 OWNER'S NAME: SERIO ROBERT JAND ROSEMARYA TRUSTEE I IDATE ISSUED: 04/11/2017 OWNER'S PHONE: 408-257-4639 PHONE NO: (916) 791-9170 IF L"al Diffellmll k1uskIt 1 010 License Class -17 Lic. #599009 Contractor BROTHERS HOME IMPROVEMENT INCDate 11/30/2018 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: 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. 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 regular the Cupertino Municipal Code, Section'9.18. Sign Date 411112017 I hereby affirm that I am exempt from the Contractor's License Law for one of the PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCLAL JOB DESCRIPTION: REPLACE WINDOWS (12) - LIKE FOR LIKE TO MEET EGRESS Sq. Ft Floor Area: Naluation: $8660.00 "N Number: Occupancy Type: 357 14 052 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbL, ey nde Date: 04/11/2017 following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. 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) a I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/11/2017 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. 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. l 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 4/11/2017 COVERINGS TO BE CLASS "A" 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 Cofly ' s 25505, 25533, and 25534. Owner or authorized agent: Date: 4/11/2017 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 t liFEliiTildiQ I (408) 777-3228 • FAX (408) 777-3333 • building(cD.cupertino.org 1:18) NEW CONSTRUCTION I I AI)I)ITION n AT III ATIIIV I II n nr vrcrnwr i �cr:co- - ----------- uvl1L CC,1\lVlll th PROJECT ADDRESS� APN # �R'%�I p 1( — cfb— z - a OWNER NAME �f _ /U'�•t PHONE �o� �/r% q�7/1 (/ ( STREET ADDRESS A® �� t CITY, STATE, ZIP FAX CONTACT NAME �- PHONE �r 7� y� S E-MAIL STREET ADDRESS 125- eo (� CITY, STATE, ZIP g /fo_131 %��C.2 CS ✓ FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR L7 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - ICENSE NUMBER / �f W ( LICENSE TYPE& 1717 BUS. LIC # ��ck j" „ l,( COMPANY NAME u Q EMAIL FAX STREET ADDRESS 1120 5 •`'f/i` CITY, STATE, ZH IP g 4l ` l Qr7w— y PHONE �% �9�` F� 0 l l l V ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP - PHONE DESCRIPTION OF WORK �,� ` d se- - 12- AhAfflIt-JI 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 REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:DETACH []ATTACH ATTACH I #DWELLING UNITS: ISA SECOND UNIT OYES SECOND STORY []YES - -- BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YESRgCEIvED EICHLER HOME? ❑ NO BY; � "�,. �, C;.', = ' � " , �;;{�`� I>> '` . TOTAL V UATION: - - By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided 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 ldin ction. I authorize representatives of Cupertino to enter the above-id�nri%tied property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMETAL RM ATION REQUIRED PLAN eT fiir [ER -THE COUNTER Cj HHiLDiNG PLAN REvnEw _ 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. Ch. ExPiiEs5 =° ".'': <<w:i D Yi AN1HNG PI AN 1i EViE�S - • _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure . . PusiaRxs ,, To—nn if an Hazardous Materials are in y e be g used as part of this project.- 'CI'�L'ARGE::-,..:: - ...........:.::t- rI;I$EDEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ,Q © sANIARY sl wi nlr�sTzeLc submittal of Building Permit application. =70H " . BldgApp 2011.doc revised 06121111