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B-2017-0689CITY OF CUP,ERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0689 23400 VIA VENTURA UNIT 16 CUPERTINO, CA 95014-6550 (342 55 001) BAYAREA I ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: SCHEPMAN BERNE ATRUSTEE & ET AL DATE ISSUED: 05/02/2017 OWNER'S PHONE: 650-944-0118 PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMT INFO: License Class 5 Lic. #$17817 Contractor BAY AREA ENTERPRISE Date 03/31/2019 X BLDG X ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH 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: UNIT 16E - INSTALL (N) LED RECESSED LIGHTS (7); OUTLETS (21); I hereby affirm under penalty of perjury one of the following two declarations: I have SWITCHES (12); REPLACE BATHROOM FANS (2) i. and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Coe, for the performance of the work for which this permit is issued. A. 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 �c permit is issued. Sq. Ft Floor Area: Valuation: $2700.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 342 55 001 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmleiss the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applican�nderstands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations pe tfie Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signaturo56{ Date 05/02/20.17 Issued by: Kim Dunbar L/ I OWNER DECLARATION Date: 05/02/2017 -BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: ' All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 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 Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). i Date: 05/02/2017 I hereby affirm under penalty of perjury one of the following three declarations: s. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Co4e, 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 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the l 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making thi certificate of air contaminants as defined by the Bay Area Air Quality Management District I 'no Municipal Code, Chapter 9.12 § will maintain compliance with the and exemption, I become subject to the Worker's Compensation proYisions of the the Health & Safe ,Sections 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked.Owner or author! ed age APPLICANT CERTIFICATION Date: 05/02/2017 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes' (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against li bilities, ' judgments, costs, and expenses which may accrue against said Cit7n Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 9,5/02/2017 Professional CONSTRUCTION P COMMUNITY DEVELOPMENT 10300 TORRE AVENUE - CUP (408) 777-3228 - FAX (408) 77-J CUPERT1140 r APPLICATION HENT - BUILDING DIVISION CA 95014-3255 - building@.cupertino.oEq 15,2o I--, - E) I - (Ti REVISION! DEFERRFD ORIGINAL PERMIT PROJECT ADD im vi&, ven+u-y-a— OWNER NAME PHONE gq-q C>1 1,, (06 ?Z # -Se- STREET ADDRESSFAX V ,#- 2 &1 " CONTACT NAME 6n%t'T�b�amws'� #4 STREET ADDRESS / 241 10 d4a Yf FIX 09- 0 0 OWNER 13 owNER-BuILUEP nOWNPRAGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 13 DEVELOPER 13 TENANT CONTRACTOR NAME -- &*fJ- lbatg hJ9-riedL LICENSE LICFW&z TYPE i e BUS. LIC 9 COMPAWYNAME Vaf, Ateet e E--MAH`6A,ee, 27X STREETAaSSU - ZZ6 a&A41&z STATE"Z(P 22 - 3,0 - J -6 C/- ARCHITrCTIENGINEERNAME LICENSE BUS. LTC P COMPANYNAME FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK /Z -f— g -;X- vt e &—A-1 7 Afe C S V EIUSTINGUSE I PROPOSED USE® CONSTR. TYPE I'STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EMIG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCHAREA DECK AREA TOTALDECKIPORCR AREA GARAGE AREA: DETACH ATTACH 9DWELLINGUNITS: ISASECONDUNIT ©YES SECONDSTORY nyES BEINGADDED? rJN0 ADDITION?' [3NO PRE -APPLICATION MYES IF YES, PROVIDE COPY OF PLANNING APDL # nNO PLANNING APPROVAL LETTER ISTHERLDGAN 13 YESTOTAL EICHLER HO NO VALUATJQN: — I By my signature below, I certify to each of e -'o amthe property owner or autficrizeft agent to act on the property ie read this application and the information I have pro�!.Z i ect. have read the Description of Work and verify it is accurate. lageeto comply with all applicable local provided s correct. I' ordinances and state laws relating to building co ctio I authorize representatives of Cupertino to enter the above -?identifid pr perty for inspection purposes. 5 Signature ofApplicant(Agent: Date: SUPPLEMENTAL INFORMA REQUIRED PLAN CHECK TYPE - ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition,pennit for ❑ OVER-THE-COUNTER 0 BMLmNGPLANRRVIEW AIsting building(s). Demolition permit is required prior to issuance of building permitfor new building. 0 EXPRESS ❑ PLANNINGPLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLIC WORKS I form ifany Hazardous Materials are being used as part of this project. El LARGE M -'CE DEPT: Copy of Planning Approval Letter or Meeting with Planmrig prior to 0 nUOR Q SANITARY SEWER DISTRICT iu6mittal of Building Permit application. CE ENVIRONMENTAL HEALTH BldgApp_2201 1. doc revised 06/271/11 Wr-X?1-WJZI M