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B-2017-0719CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19832 PORTAL PLZ CUPERTINO, CA 95014-3363 (369 46 020) OWNER'S NAME: MATHACHETTY RADHAKRISHNAN AND KRISHNAN MAHA OWNER'S PHONE: 408-921-5438 LICENSED CONTRACTOR'S DECLARATION License Class B: C-17 Lic. #627677 Contractor PHILLIP ISAACS' CONSTRUCTION INCORPORATED Date 04/30/2019 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: 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 rformance of the work for which this permit is issued. 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 ermit 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. Signature Date 5/5/2017 OWNER -BUILDER DEC N 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 compensation, will do the work, and the structure is not intended or offered for CONTRACTOR: PERMIT NO: B-2017-0719 PHILLIP ISAACS' CONSTRUCTION INCORPORATED RANCHO CORDOVA, CA 95742 DATE ISSUED: 05/05/2017 PHONE NO: (916) 852-8132 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE WINDOW (3)- TO MEET EGRESS; REPLACE PATIO DOOR (2) Sq. Ft Floor Area: I Valuation: $6500.00 "N Number: Occupancy Type: 36946 020 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende RF. -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. sale (Sec.7044, Business & Professions Code) Signature of Applicant: z. I, as owner of the property, am exclusively contracting with licensed Date: 5/5/2017 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 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 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. 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 Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 5/5/2017 I hereby affirm that there is alsoastra on 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 CUPERTINO F_)-2 A-- cgtq CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • building a0cupertino.org I I NFW rnTQRTRI IC T`10N 7 AnnrTlnN n A17FRATION / TT n REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS —/ 'Z �U2 �� h iU - (J,r!1 — Q 7 / APN 4M5 `�5 OWNER NAME / 1 r,l /42N 544 MA PHONE r O q ' � Z � � di E-MAIL STREET ADDRESS �J �U �j L CITY, ST`T TE, ZIP !©/Lt FAX CONTACT NAME JEFF RAINEY PHONE 510-427-4260 EMAIL jeffrey.rainey@att.net STREETADDRESS 1069 EDGEMERE LANE CITY, STATE, ZIP HAYWARD, CA 94545 FAX 510-783-1041 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑` TENANT CONTRACTOR NAME �� LICENSE NUMBER .Z 767 LICENSE L E SCYP � BUS. LIC # %L+q 4J / E-MAIL IC t.6 --Fi43f- ?^� Z COMPANY NAME /' ,�/ � l'CC_� ! I STREET ADDRESS , r`'Y/�^� TATE ZL��✓�C^PHJE l�Atvk--ff / I 5?� Z/1 ARCHITECT/ENGINEER NAME LICNSENUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � gyp.- t ,� I r1 1 V L✓ 17CZ� EXISTING USE PROPOSED USE CONSTR TYPE #STORIES Z USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH I # DWELLING UMTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # E] NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECIEIV BY: n y ,� //I y TOTAL VALUATION: / 5C �-j --C/fl By my signature below, I certify to each of the following: I am the property owner or autho�agentn t e property owner's behalf.'I have read this application and the information I have provided is correct. I have read the Description of Waccurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives o above -identified property for inspection purposes. Signature of Applicant/Agent: Date: �/ S�) / SUPPLE T RMATION REQUI PLAN CHECK TYPE ROUTTNG SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for de on permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doe revised 06/21111