B-2017-0971CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0971
19845 PORTAL PLZ CUPERTINO, CA 95014-3367 (369 46 999)
SANCHEZ ELECTRIC
INC
SAN JOSE, CA 95111
OWNER'S NAME: PORTAL PLAZA
DATE ISSUED: 06/20/2017
OWNER'S PHONE: 408-255-2744
PHONE NO: (408) 281-9854
LICENSED CONTRACTOR'S DECLAR TION
BUILDING PERMIT INFO:
License Class "- Lic. #649637
Contractor SANCHEZ ELECTRIC INC Date 06/30/2018
X BLDG X ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RESIDENTIAL COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
CP -9; LOWER 1/2" CONDUIT IN ORDER TO ALLOW FOR NEW
I hereby affirm under penalty of perjury one of the following two declarations:
GUTTER; REPLACE 3 (E) CARPORT LIGHTS
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.
. 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
i Y permit is issued.
Sq. Ft Floor Area:
Valuation: $2800.00
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 46 999
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.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source reg tions per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/20/2017
C7
Issued by: AbbyAyende
f
OWNER -B iiL.D .R DE L RATION
Date: 06/20/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
r. 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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 6/20/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. 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
Worker's Compensation laws of California. If, after making this certificate of
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
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety C , Sections 25505, 25533, 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: 6/20/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
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
ARCIHTECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 6/20/2017
Licensed
Professional
CUPERTINO
GENERAL PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(okupertino.org
PLUMBING I (MECHANICAL N/. FJ'TRU'er 17Inerc11nr r Arrcnrrc
MISIC
PROJECTADDRESS 19845 Portal Plaza
APN# 36946999
OWNERNAME Portal Plaza HOA
PHONE 408-255-2744
L-MAIL
Theo.kubalek@sbcglobal.net
STREET ADDRESS 19845 Portal Plaza
c"'NATE lno, CA 95014
FAX
CONTACT NAME
PHONE
E-YtAll.
it h
-7-
IanchezElectricAet
STREET ADDRESS
5096 Edenview Drive
CITY, STATE, ZIP
San Jose, CA 95111
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT
❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
Gilbert Sanchez
LICENSE NUMBER
CA 649637
LICENSE TYPE
C-10
BUS. LIC #�'�,n "7
COMPANY NAME
E-MAIL,
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
5096 Edenview Drive
San Jose CA 95111
408-679-1208
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX MULTI -FAMILY
PROJECT W WILDLAND El YES
PROJECT IN ❑YES
IS THE BLDG AN ❑YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
Lower 1/2" Conduit in order to allow for new Gutter. Replace 3 Existing
Carport Lights at CP9 Carport
TOTAL VALUATION: $2,800
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owners behalf 1havereadthis
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 buildingnstruce, . 'authori a representatives of Cupertino to enter the above -identified
property for inspection purposes.
Signature
of Applieant/Agent:L'
> Date: __ 6/20/17
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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MEPMiscApp_2011.doc revised 06121111
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