B-2017-0893CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO: B-2017-0893
10311 LOCKWOOD DR CUPERTINO, CA 95014 (342 30 032) TEAM CONTRACTORS
SAN JOSE, CA 95111
OWNER'S NAME: EVERARD WILLIAM A AND LECOMPTE BARBARA C TR
DATE ISSUED: 06/05/2017
OWNER'S PHONE: 808-388-6817 1 1 PHONE NO: (916) 417-3017
License Class @ Lic. #835209
Contractor TEAM CONTRACTORS Date 04/30/2018
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:
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.
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.
PERMIT INFO:
BLDG —ELECT X PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
DESCRIPTION:
,ACE BUILDING SEWER AND REPLACE SEWER MAIN
Sq. Ft Floor Area: I Valuation: $6500.00
APN Number: Occupancy Type:
342 30 032
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature ZI ah"b" Date 8/5/2017 Issued by: Abby Ayende
Date: 06/05/2017
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
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.
z. 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.
Signature Date 5(5/2011
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 6/5/2017
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 Code, Sections 25505,, W5�333,, .,and 25534.
Owner or authorized agent:
Date: 6/5/2017
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
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
9PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
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❑ OWNER ❑ OWNER -BUILDER
❑ OWNERAGENT M CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER .
LICENSE TYPE
BUS. LIC #
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BUS. LIC #
COMPANY NAME
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STREET ADDRESS
CITY, STATE, ZIP
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USE OF ❑ SFD or DUPLEX
❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
PROJECT IN El YES
IS THE BLDG AN ❑YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION:
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RECEIVED BY: owiffizu
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o er's be alf. 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 building tructi I authorize representatives of Cupertino
to enter the above-ide tifi d property for inspection purposes.
Signature of Applicant/Agent:
Date:
SUPPLE AL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTER
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❑ EXPRESS
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MEPMiseApp 201 ].doe revised 06121111
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 • Fax (408) 253-5173
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'�r-�sae�a�utiww CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over -the -Counter)
P<ngle Family Project
Project Address: 'I ®31 l
❑ Multi -Family Project
ucff!wuoi 11.
❑ Commercial Project
Permit Number: X20\1 " M_ )
Scope of Work: S.eWerkiylt f gV'Lc m(V'*-
Owner/Applicant Name: Jol-eV1 L t, CGLC 1. A Phone:
Address:t021 i 10c V_LQ t�.)� J `�fn.
Date: J Prepared By: m �`^'1"i4�''
City Authorized Representative
1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project.
Date: / Signature:
% r Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required Final Inspection Required
Date Scheduled:
Date: Conditional Approval By:
Authorized Representative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc
City of Cupertino. _
Inspection Fee Paid Date Paid: (.Q - —1-7
Inspector Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
$150/unit - Single Family Residential already connected with existing cleanout in working order
$350 Minimum — Commercial and Retail Actual Amount:
D $200/each — Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit - Single Family Residential connecting to existing lateral
$650/unit — Single Family Residential connecting with new lateral
$100/unit — Multi, Hotel, Living Units, etc. Actual Amount:
D $500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
Area and Frontage Fees Amount:
Residential Excess Fees over 3.5 unit/acre Amount:
D Commercial and Retail Connection Fees Amount:
D Commercial and Retail Change in Use Fees Amount:
Date: (�a ^ S- (7 Final Approval By:
Authorized �ep esentative
Cupertino Sanitary District