The URL can be used to link to this page

B-2017-1076CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1076 20217 NORTHBROOK SQ CUPERTINO, CA 95014-0501 (316 39 033) JEFFREY L FORCIER CONSTRUCTION CO HALF MOON BAY, CA 94019 OWNER'S NAME: BENHAM MARY H TRUSTEE OWNER'S PHONE: 310-545-6549 License Class @ Lic. #510906 Contractor JEFFREY L FORCIER CONSTRUCTION CO Date 05/31/2019 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: 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. 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. I Signature ate 7/6/2017 RATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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. 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 1 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. L�� ZDTPZGIVA DATE ISSUED: 07/06/2017 PHONE NO: (650) 726-1129 PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: K REPLACEMENT - LIKE FOR LIKE (150 S.F.) Sq. Ft Floor Area: Valuation: $10000.00 APN Number: Occupancy Type: 31639 033 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende 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 ofAl Date: 7/6/2017 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 & SafetyCode, Sections 2 5 5, 255 3, and 25534. (( Owner or authorized agent.{ Date: 7/6/2017 I hereby affirm that there is a constructs &aJgnding 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 • building -cupertino.org 13 20 n -- t 6 1-4 [:]NEW CONSTRUCTION ❑ ADDITION \ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJE '7 APN # 03 ORT CI(J S OWNER NAME PHONE _A0 -J �" E-MAIL STREETADDRESSy//`=/ 25/ N p CITY STATE, ZIP ^ FAX CONTACT AME P ONEE-MAIL o -5_3 3 A g STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT Isr CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ✓ r Jeo LICENSE NUMBER 01906 C__ 16 LICENSE TY P c5Lz f BUS. LIC # W66!5 COMPANY NAME '�«i E-MAIL FAX Y.FFR 10 Sr �onci� S �[ s ADDRESS YE TT 11 GF MO 7N6 G4 67 t PHONE CSc- 2533 -q el :, ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE n� I - DESCRIPTION OF WORK n(2�� /, ,, �: a vG% /cam; /'� K(- AW Wo ( r r�� i rc- GIR�,evv of PC --c,1,<, APa -P,,>s 4-F��'>/vGs 7-:9 r pcZ'1c:5af f' oN tW rl /& Cacti 7_0 /:14 SH IJ&W A OaKIS 1ivG- J i Jv EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE I 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 DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS' ISA SECOND UNIT ❑ YES SECOND STORY ❑ YES BERVG ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEI BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER ROME? ❑ NO /D `D By my signature below, I certify to each of the 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 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 ildi g construction. I authorize representatives of Cupertino to enter thea ve-id tified property for inspection purposes. Signature of Applicant/Agent: Date: �1 SUPPLE TION REQUIRED PLAN CH K TYP ROUTING SLIP vIi, 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 ANNING PLAN REVIEW tBLICWORKS _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD 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 06121/11 July 6, 2017 Northpoint Homeowners Association 10880 Northpoint way, Cupertino, CA 95015 Donovan Lazaro Planning Intern City of Cupertino Community Development 10300 Torre Avenue, Cupertino, CA 95014 RE: 20217 Northbrook Square, Cupertino CA 95014 Dear Mr. Lazaro, The owner of 20217 Northbrook Square has contacted the Association to request permission repair the deck. The Association approves the repairs as submitted with drawings and application by Jeffrey L. Forcier License #510906, 6-36, Jeffrey L. Forcier Construction Co. At this time the HOA has no cause to prevent this repair; however, they Association does require a copy of the permit once it is granted by the City of Cupertino. If there are any further questions, please contact me directly at the information listed below. On behalf of the Northpoint HOA, era[ Manager Northpoint HOA 10880 Northpoint Way Cupertino, CA 95014 Office: 408-996-3734 Fax: 408-996-0226 email: manage r(cDnorth pointhoa.com 10800 Northpoint Way, Cupertino, CA 95015 manaeer(i�northpointhoa. com