B-2017-1026CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1026
10067 BYRNE AVE CUPERTINO, CA 95014-2805 (357 11 003) GABRIEL
CONSTRUCTION
COMPANY
SAN JOSE, CA 95125
OWNER'S NAME: SINGH INDERJEET TRUSTEE & ET AL
OWNER'S PHONE: 408-390-4560
111 Lei osem 01 wowu 0 mi" kill -,V-1
License Class @ Lic. #1004259
Contractor GABRIEL CONSTRUCTION COMPANY Date 06/30/2019
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
12: 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, thea plicant understands and will comply with all non -point
source regulatio s per the Cupe ' o Municipal Code, Section 9.18.
Signature Date 6/28/2017
DATE ISSUED: 06/28/2017
PHONE NO: (408) 753-9638
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
PATIO COVER FREE STANDING (290 S.F.)
Sq. Ft Floor Area: I Valuation: $5500.00
APN Number: Occupancy Type:
357 11 003
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
Date: 06/28/2017
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 fust 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 ofApl
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 6/28/2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. I bave 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 6/28/2017
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 Ciortino Municipal Code, Ch ter 9.12 and
the Health & Safety Code ections 25505, 25533, a 5534.
Owner or authorized ageni:
Date: 6/28/2017 CONSTRAION 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildina(a)cuoertino.org 2
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
ts
PROJECT ADDRESS ^
APN# Z
D
O"MNTERNAME C' PHONE 4v 310
E-MAIL
STREET ADDRESS
X06
CITY, STATE, r n FAX
CONTACT NAMEPHOT
S
E E-MAII.
�l
S 7f
STREETADDRESS<
CITY,3TE, ZIP // -2—
FAX
❑ OWNER ❑ OWNER-BUII-DER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUhfl LICENSE E
BUS. LIC #
Oo
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS n
CITY, STATE _
""'
4U
of
8
ARCHITECT/ENGINEER NAME . LICENSE NTUMBER
BUS. LIC #
COMPANY NAME r
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
�
DESCRIPTION OF WORK C4U
1
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
I 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 DECKIPORCH AREA
GARAGE AREA: LJDETACH
I
❑ ATTACH
# DWELLING UNTITS:
ISA SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BELNGADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
CEIVED BY -
TOT& VALUATION:
PLAN''NTNG ADPL # ❑ NO PLAN'NLNG APPROVAL LEITER
EICHLER HOME? ❑ NO
Y^
Ui
-oz)
IJP
By my signature below, I certify to each of e following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pr ded is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ng
ordinances and state laws relating to b construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: �'4A.Q '—�n I
SUPPLEMENT. TION REQUIRED
PLAN CHECKTITE
❑
New SFD or Multifamily dwellings: Apply for demolition permit forcovN"rER
existing building(s). Demolition permit is required prior to issuance of building
13131rDDNG PLAxRE«w
permit for new building.
❑ EXPRESS
❑ PLAN'NINGPLAN REVIEW "
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑STAI�'DARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
F-1 DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑. 314 4 iOR
❑' SAN
submittal of Building Permit application.
. SE�i ER DISTRICT.
�❑ ENVTRONNMNTAL HEALTH
BldgApp_2011.doc revised 06/21/11