The URL can be used to link to this page

B-2017-0983CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0983 10670 CORDOVA RD CUPERTINO, CA 95014-3912 (342 17 053) LEBEC INC BRENTWOOD, CA 94513 OWNER'S NAME: WEST DENNIS L AND BARBARA J OWNER'S PHONE: 408-981-0801 LICENSED CONTRACTOR'S DECLARATION License Class A Lic. #930961 Contractor LEBEC INC Date 04/30/2019 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: 1. I have and will maintain a certificate of consent to self -insure for Worker's ompensation, 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 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. Signature x..1`67/ y-- Date 06-22-2017 ISSUED: 06/22/2017 PHONE NO: (925) 634-4177 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPAIR/SHORE (20 LF) RETAINING WALL WITH GUARD RAIL (42" HIGH 4" SPACING). Sq. Ft Floor Area: I Valuation: $8000.00 APN Number: Occupancy Type: 342 17 053 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 06/22/2017 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 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) 2. 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. s. 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 I!IIFsI:1P*&1ijiN Signature of Applicant: Date: 06-22-2017 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 & Safe is 25505, 25533, and 25534. Owner or authorized agent: Date: 06-22-2017 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 (0 - C - M 2- PM CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org 3 -ZV 1 1- -b Q 83 ❑ NEW CONSTRUCTION ❑ ADDITION IO ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS j 0 �q-1 () APN # y�.. l 7. 5 3 OWNERNAME'0 /� 1 PHON4Do 0 � 0 E-MAIL STREET ADDRETO U-7 0 OI I NO CU FAX CONTACT NAME L_E V v 1 ' A ' C- 1 V I { L• �4t 11, E AIL • ' �► ^ �' STREET ADDRESS I T ,STAT IP o A CA !l❑A'LI#ARCHITECT FAX V El OWNER 11OWNER-BUILDER El OWNER AGENT CONTRACTOR 11 CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME C CE SE NU ERL CENS YP BUS. LIC # COMPANY NAME LEDEC, IN(. N(. E M � N C • COM FAX STREET ADDRESS PC -&O y( 11-1 (6 � ,�ZZI boid C Q ` 5 5 1• � 4 1-1-7 ARCHITECT/ENGEQEER NAME d 1 LICENSE NUMBER C I _I � BUS. LIC # �- � COMPANY sixu =jai M E-MAIL FAX ST5& A D S t � - 4 ^ ^ TY, STATE, I�� CA 0 (� 1 /1 3 -1 i QNE 3 ^ ^ 50-7 �(„ �N./�V�' "� 1 V \NA1 1 •/� DESCRIPTION OF WORK j �. L� 1�1 a. p Side ire e -eJ tNo Ntt i NO. EXISTING4SE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT E]YES SECONDSTORY []YES BEING ADDED? NO ADDITION? []NO PRE -APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN E] YES REC VED B TOTAL VALUATION: PLANNING APPL # E]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 00.1 S By my signature below, I certify to each of the following: I am the property owner or authorized ag& to act on the property owner's behalf. I have read this application and the informatio ded c. a the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rel g t b i ion. I authorize representatives of Cupertino to enter the above-identifi�,d property for ins ct.on purposes. Signature of Applicant/Agent: Date: (%i SUPPLEMENT ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP. ❑ OVER-THE-COUNTER �BUILDI G PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building, 1 permit for new building. ❑ EXPRESS �PL ING PLAN REVIEW ;•jJj 1��'/'tn� 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 ❑ FIRE DEPT , Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. -❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11