B-2017-0901CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0901
10404 LANSDALE AVE CUPERTINO, CA 95014-4516 (369 12 006)
P & E CONSTRUCTION
SAN JOSE, CA 95123
OWNER'S NAME: SANDERS LINDA M TRUSTEE
DATE ISSUED: 06/07/2017
OWNER'S PHONE: 408-859-3316
PHONE NO: (408) 799-3406
LICENSED ONT A TOR'S DECLARSTION
BUILDING PERMIT INFO:
License Class la Lic. #90Ei711
Contractor P & E CONSTRUCTION Date 11/30/2017
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:
RESTUCCO SFD (1400 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.
AQ2. 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
Sq. Ft Floor Area:
Valuation: $14000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
369 12 006
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 regula ons per the Cupe 'no Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/7/2017
Issued by: Abby Aygnde
Date: 06/07/2017
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)
i. 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: 6/7/2017
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
i. 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
s. 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 ections 255 , 255 and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6[7/2037
I certify that 1 have read this application and state that the above information is
CON TRUCIN LENDA AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a co truction 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 6n/2017
Professional
CUPERT[NO
P) -Z01 -+-0q01
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.or4
LJ NEW CONSTRUCTION LJ ADDITION LJ ALTERATION / TI LJ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS acl j 7# ``� / Y •i n
OWNER NAME 4 PHONE 4Q , 96S 33) 1 (/E- (MAIILL�1'
STREET ADDRESS CITY, STATE, ZIP C� Q ` • ` FAX
CONTACT NAMEv ; Z PHONEc)E ! (5w-
-�v,l6 E-MAM
STREET ADDRESS _ i I h CITY, STATE, ZIP C ( le I FAX
EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION (S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
❑ ATTACH
# DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑ YES
BEINGADDED? E] NO ADDITION? E] NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESIVED BY T T ALUATION:
PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? [3 NO snD
„r '
By my signature below, I certify to each of the following: I am the property owner or authorized agent to ct 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 touilding cons tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: tiffit ( 111/2% Date: A-1-17
_ 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.
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp_2011.doc revised 06121111
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME i 7
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LICENSE ER
LICENSE TYPE
BSOLjG _ /
COMPANY NAME
V\Y L� �0 V\
E-MAII. -
(2 a)v vL
FAX
STREET ADDRESS ,_
CITY, ST TE, ZIP b I
P$06 _
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK t, 4_ t I (I o
Ill "[U�f
EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION (S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
❑ ATTACH
# DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑ YES
BEINGADDED? E] NO ADDITION? E] NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESIVED BY T T ALUATION:
PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? [3 NO snD
„r '
By my signature below, I certify to each of the following: I am the property owner or authorized agent to ct 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 touilding cons tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: tiffit ( 111/2% Date: A-1-17
_ 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.
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp_2011.doc revised 06121111