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B-2017-0165CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0165 21962 LINDY IN CUPERTINO, CA 95014-4832 (356 24 012) A L L CONSTRUCTION CAMPBELL, CA 95008 OWNER'S NAME: MOORE JAMES AAND SUSAN M TRUSTEE DATE ISSUED: 05/17/2017 OWNER'S PHONE: 408-253-4574 PHONE NO: (408) 605-1212 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #843743 Contractor A L L CONSTRUCTION Date 07/31/2018 X BLDG _ELECT —PLUMB MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: KITCHEN REMODEL (140 S.F.); KITCHEN ADDITION (157 S.F.) 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 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by 17 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: 157 Valuation: $35000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 356 24 012 R-3 (Custom) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Si 5/17/2017 Issued by: AbbyAvende ._.,_. Date: 05/17/2017 OWNER-BUIL;'6;�ARATION 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 t. 1, 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) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 5/17/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by 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 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 air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall 1' be deemed revoked. Owner or authorized ageiM--------�/�� APPLICANT CERTIFICATION Date: 5/17/2017 >>,O� 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 ONSTRVTIN LENDING A = .N Y 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 liabilities, judgments, costs, and expenses which may accrue against said City in 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 17 Professional -Zo�q o� J CONSTRUCT[ON' PERMIT APPLICAT[ON COMMUNITY DEVELOPMENTDEPARTlv1ENT •BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 rG�IiPEFtTINC3 (408) 777.-3228 • FAX (408) 777-3333 ••building cuPertino.org I XI V✓C'.ONRTRiIC'TION ADDYMON • F AT'FT-PATI-llU/TT I ^1 RPVM1n1J/11F1:T:RRFrI nRir,TIIeI c7utirTr-4 PROJECT ADDRESS d l'L OWNERNAi4E PHONE E-AL4IL Sys,��S ao�.� ©° , Z5"3•�}S" svc:MMoC�c'v�c_�_s_.ri STREET.ADDRESS / `� CJTY,.STATE,ZIP FAX �Fy / G_. L (...� i'j �12•T / /� l� [• �(- CONTACT NAA4E A R Q PHONEgciJ 7,3 E•?,4AIL STREETADDRESS CITY TATE, ZIP I FAX 7� - L�ex, L�1 —�- ❑ ON'1.ER Cl oNNNER•BUTJ.DER Cl OVITIERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ INGINEER 0 DEVELOPER ci TENANT CONTRACTOR NAME ! 61� LICENSE NIJArBFR%l j f� , ..I' LICENSE. TYPE BUS, I.1C COMPANYNAME E -M 1 FAX CC, STREETADDRESS/ CITYST.aTE,Z �e (� �. �C _ PHONE / �j ARCHITECl/ENGMIERNA.ASE LIMNSEA' (BIR BUS. LICS -- `—.___._-_____�• •.A COMPANY NAME E-),4AIL --�•-�"-^MY+�� FAX STREET,ADURESS �•'.���-....�..�..•_ CJTY,ST.AT1.,7.IF �_......� PHUIdE��._-���w� DESCRIPTION OF WORK. �j { EXISTA'GIJSE re L'S r PROPOSEDUSE CONSTXTwE J� ftSTORIE� ��w�- USE - TYPE OCC. -��•••- SQ.FT. - - VALUATION (S) ECISTG NEW FLOOR DEh40-� TOTAL APMA ..1 AREA AREA 11ETAR.EA i BATHROOM .KITCHEN OTHER RF_A40DELAREA RF,MODELAREA J�,,� PZN40DELAREA PC)RCHAREA DECK AREA 701ALDECK!POR RAREA GARAGEAREA: DETACH _ '"— �'A7TACH F DWELLVgG UNITS; ISA SECOND CHIT ❑YES SECO?`D STORY E ' BEIING ADDED? ❑NO ADDITION? W0 PRE -APPLICATION ❑ YES , IF YES, PROVIDE COPY OF PLANJQNGAPPLR ❑NO PLA1NWGAPPROVAL LETTER IS THE BLDG AN [J S'ES EICHLERHOME? ❑NO r EIVED' ti y ', a� '� nS. T ' AL•. VALUATIO '• ° s `� vIOO By Iffy signature below, 1 certify to each of the follor'in I am e property owner or authorized age t to act n the.property`owner's behalf. I have read this application and the information I have provided is Lorre'read the Description of l4rork and verify itis accurate. 1 agree to comply r�'itJf 211 applicable local ordinances and state laws rel to bVu g construe 1 u orize representatives of Cupertino to enter the above -'d M d pro erty for inspection purposes. SignatureofApplicant/_ '"` Date; Z / SUPPLEMENTAL lNF AT ONT RE UIRED ��v PLA1 CIiF,CR TiPE..i 1.? -„c Ire t avr f.f20 UTINC�iL1I_1 01 ):R 1'HE OOU�TER�` � IillILD1NG PI A,'` RE\TEV,I New SFD or Multifamily dwellings: Apply for demolition perinif for existing building(s). Demolition permit is required prior to issuance of building� , p, F } pemit for new building. - Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD �L� rLBLIc-\SORkS fonn if any Hazardous Materials are being used as pall of this project, t ` 5 Copy of Planning Approval Letter or Meeting with Planning Prior to w F e kLA10R " ti 0 r '�^ +�` F t: 3 ..Y,,,. -b• submittal of Building Permit application. r a , If wy rk! c 4 ' ATY.t er'y ; •? i 54 IT4RY SE1NTRDI9TRICT gc x L `� :d' �.Y.`^F�' 1. +f,..'su .3�'- : C`. ' ". i i ;e:. yt: F 071RONh1ETTAL: HEALT1i BldgRpp_201I.doo revised 06/21/11 T N,::� OAT