Loading...
B-2017-1012CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1012 10326 TONITA WAY CUPERTINO, CA 95014-2932 (359 15 050) HOME DEPOT U S A INC ATLANTA, GA 30339 OWNER'S NAME: GERNER KARL J AND DEANNA J TRUSTEE DATE ISSUED: 06/26/2017 OWNER'S PHONE: 408-832-337 PHONE NO: (770) 433-8211 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B: C-39: C-13: C-17 Lic. #602331 Contractor HOME DEPOT U S A INC Date 09/30/2018 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: REPLACE WINDOWS (6) - LIKE FOR LIKE TO MEET EGRESS; I hereby affirm under penalty of perjury one of the following two declarations: REPLACE SIDING (1400 S.F.) tI 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. 0.1I 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: $4717.00 ermit 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 359 15 050 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 p9iat- � source regulations per the Cupertino Municipal Code, Se rr .I 180 DAYS FROM LAST CALLED INSPECTION. SignatureDate 6/26/2017 Issued by: Abby Avende TILDFR ION Date: 06/26/2017 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 t. 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) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: 6/26/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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 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 Code, 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: 6/26/2017 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 I hereby affirm that there is a cons n 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. Signature Date 6/26/2017 Licensed Professional CVPERTINO 12 -10 CONSTRUCTION PERMIT APPLICATION �-�Z01� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS j /ti '5 -LL �� I 1 TA ��i APN # �� - 1� .- O � /� OWNER NAME + /i�A3 1. �` 4 (� PHON�� �� ` .�,� E-MAIL STREET ADDRES 1 O 512— 70A I —TA k) A -r CITY, STATE, ZIP GJ�c,Z� I C U L A 9 50/4 FAX CONTACT NAME JEFF RAINEY PHONE 510-427-4260 E-MAILJEFFREY. RAINEY@ATT. NET STREETADDRESS 1069 EDGEMERE LANE CITY,S--TATE, ZIP HAYWARD, CA 94545 FAX 510-783-1041 11 OWNER 11OWNER-BUILDER11 OWNER AGENT ❑ CONTRACTOR `Gl CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # 403136 602331 B,C39,C13,C17 COMPANY NAME E-MAIL FAX HOME DEPOT USA 510-357-3750 STREET ADDRESS CITY, STATE, ZIP PHONE 2456 VERNA COURT SAN LEANDRO,CA 94577 510-877-4550 ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK L � -PC f [ 7 � ��1'l y � ��� I � /7� � 5 I )< /� 1`C `-CJ (,✓ I f T/It- EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES © k_ N 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 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TO AL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO , _ _ /) •Z� 2— 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 to building constructio representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: lit -21 11-7 SUPPL NTAL INFORMA;red PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUHDINGPLAN REVIEW New SFD or Multifamily dwellings: Appolition permit for existing building(s). Demolition permit is reqrior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD ElPUBLIC 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 El MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121/11