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B-2017-0927CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0927 19845 PORTAL PLZ CUPERTINO, CA 95014-3367 (369 46 999) EMERY CONSTRUCTION & DESIGN CAMPBELL, CA 95008 OWNER'S NAME: PORTAL PLAZA DATE ISSUED: 06/12/2017 OWNER'S PHONE: 408-225-2744 License Class B Lic. #836600 Contractor EMERY CONSTRUCTION & DESIGN 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: r. 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. I have apd will maintain Worker's Compensation Insurance, as provided for by on 3700 of the Labor Code, for the performance of the work for which this permit is issued. I 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 6/12/2017 r' I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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. 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. Signature Date 6/12/2017 NO: (408) 369-0673 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: /CARPORT - REPLACE (3) 4 X 12 BEAMS CP -q Sq. Ft Floor Area: I Valuation: $1500.00 APN Number: Occupancy Type: 369 46 999 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 06/12/2017 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: 6/12/2017 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, 25533, and)5334: Owner or authorized agent: / Date: 6/12/201 CONS Rllcilmj�IN I hereby affirm that there is a construction lendin gency 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 91ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 19845 Portal Plaza APN# 369-46-999 OWNER NAME Portal Plaza HOA PHONE Lo 2x -3 -1144E J(�Cupertino, -MAIL STREET ADDRESS 19845 Portal Plaza CITY, STATE, ZIP CA 95014 FAX CONTACT NAME Theo Kubalek, HOA President PHONE 408-225-2744 T'-"Ifheo.kubalek@sbcglobal.net STREET ADDRESS 18981 Portal Plaza CITY, STATE, ZIP Cupertino, Ca 95014 FAX ❑ OWNER ❑ OWNER -BUILDER Ek WNER AGENT ❑ CONTRACI"OR ❑ CON"FRACrOR AGEN"F ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Holly A Emery LICENSE NUMBER 836600 TLICFNSF TYPE B BUS LIC # 403246 COMPANY NAME EmeryConstruction & Design 9 E-MAIL emery_construction@comcast.net FAX 408-369-0683 STREET ADDRESS 155 E. Campbell Ave, Ste 235 CITY, STATE, ZIP Campbell, CA 95008 PHONE408-369-0673 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS_ LIC # COMPANY NAME E-MAIL FAX STREET ,ADDRESS CITY, STATE., ZIP PHONE DESCRIPTION OF WORKAt Carport CP- 9, replace (1)(e) 4x12x22'-0" Doug Fir beam with new 4x12x 22' Doug Fir beam 8x8x Simpson RFB#5 5t8" threaded bulted to (e) notched pust w/ (2) x16 lads through top and bottom - use BP3 5/8" washers - replace (2)(e) DF 4x12x beams front and back w/ Simpson LUS410 ga hanger(s) w/ #16 SDS - A35 clips at joists as needed EXISTING USE carport PROPOSED USE CONSTR. TYPE ft STORIES one USE TYPE OCC SQ.FT. VALUATION IS) EXISTG NEW FLOOR DEMO TOTAL AREA AREA .AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL. AREA PORCH AREA DECK AREA TOTAL DECK,PORCH AREA GARAGE AREA. DETACH ❑ ATTACH !p DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY—OYES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG ANYES EIC'HLER HOME? X NO RE,(�EIVED BY: TOTALLVALUATION : 1,500.00 PLANNING APPL N ❑ NO PLANNING APPROVALLETTER I(VIWY�4 By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on 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 Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to buildi g ITS coon. I autho e representatives of Cupertino to enter the above -identified property for inspection purposes. 9' Signature ofApplicant/Agent: � " Date: —.Cal9' SUPPLEMENTAL INFORXATION REQLII PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a Completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ ❑ LARGE EIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR El SANITARY SEWER DISTRICT Submittal OfBUllding Permit application. ❑ ENVIRONMENTAL HEALTH B1dg.4pp_2011.doc revised 06/21/11 (e) 2x8x joists in ® 16" o.c. 8'-0" tyP 8'-6" typ Ile I/ (e) roof deck – 1/2" ply w/ tar & gravel (e) 2x8 016"o.c. w/ 2x8 blocking each bay A35 clips as needed / Simpson LUS410 w/ #16 SDS r/ (r) (e) 412 beam between posts front & back open (e) 2x12x fascia w/ 2x2x 26 go cap (r) (e) 4x12x each side of post w. (2) Sim RF65x 16 5/8" threaded rod w/ BP3 washers (e)8x8post notched to receive (2) 4x12x — open PORTAL PLAZA HOME OWNERS ASSOCIATION replace – existing conditions VI ��# FOR C TT ��F T Traci NE6 g ark Plaza Rev'ewe & i nt @tM, page 46, lot 81 J-' 19845 Portal Plaza Cupertino, CA 95014 HOA Board President: Theo Kubalek phone: 408-255-2744 email: theo.kubalek@sbcglobal.net