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B-2017-1090CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1090 7670 BERLAND CT CUPERTINO, CA 95014-5079 (362 25 034) PRUDHON BUILDERS SCOTTS VALLEY, CA 95066 OWNER'S NAME: HO KENNETH S AND DEBBIE Y TRUSTEE I I DATE ISSUED: 07/19/2017 1 OWNER'S PHONE: 408-813-4058 I I PHONE NO: (408) 390-7251 I License Class @ Lic. #ZZ637Ei Contractor PRUDHON BUILDERS Date 03/31/2018 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. 1 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 on 3700 of the Labor Code, for the performance of the work for which this permit is issued. ' V 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 regulation er the 01 ertino Municipal Code, Section 9.18. Signature Date 07/19/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 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. 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 07/19/2017 BUILDING PERMIT INFO: BLDG X ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: Is FLOOR BATH REMODEL (33 SF)- 2ND FLOOR BATH REMODEL (2) (123 SF); (N) CEILING LIGHTS (12) Sq. Ft Floor Area: I Valuation: $44000.00 "N Number: Occupancy Type: 36225 034 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: 07/19/2017 RF -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 of Applicant: Date: 07/19/2017 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 Cupertin Munici al Code, Chapter 9.12 and the Health & Safety Code, Sec ' s 25505 5533, and 25534. Owner or authorized agent: �& /Xe� Date: 07/19/2017 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (cbcueertino.org 9 -ZD' I ^ /050 n t pw rnTTCTRT T( TTnN n An1)TTTnN ALTFRATTON / TI n REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS1 O 8ER L AN L CT a) CUPE�71� 7670 °PN# OWNER NAME �jENAJF{H NQ PHONE CITY, STATE, ZIP C "EEOZI r �o ca 950 4 STREET ADDRESSI 7670 6 7O S -ER L A O (1, c L{ QE 2, "i I FAX I CONTACT NAME k E g t4� T H H© PHONE STREET ADDRESS 7670 6 FRL A N D C- 1 CITC LAATE&R--TI Alio C A 9 5v 1 4 FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �+.J' Te , V b 0 / J I ,1�I LICENSE NUMBER � iE � � L / O LI ENS �� �L (i BUS. LIC # 4 0 4 Y r b .j jPk r� c COMPANY NAME -pe L c)1V �LJ/ �MA� ' FAX //� ��IQQe N� S77tEETADDRESS 3c°� S. `/'-1 N�11 CITY, ST E! �.S v.44,try cq PHONETO� ARCFIITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE E}►J +`/� 0 o M 5 R R IEM O bE r DESCRIPTION OF WORK 6A -IH ADD 12 (FILING LIGHTS 7o 3 BEP ROOMS EXISTING USE IgA T H PROPOSED USE CONSTR 6A114 TYPE Ma O C L # STORIES 2 USE TYPE OCC. SQ.FT. VALUATION (S) AARREA G 259 AAREA 2 5 T LOOR rRf � 2 7 4 TOTAL BATHROOM REMODEL AREA 2 5 `� KITCHEN REMODEL AREA O OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: WDETACH ATTACH 140 140 # DWELLING UNITS: IS A SECOND UNIT OYES BEING ADDED? NLNO SECOND STORY [TY—ES ADDITION? �0140 PRE -APPLICATION []YES IF YES, PROVIDE COPY OF - PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? []NO D TOT.pp7 4 `VALUATION: S O/j V By my signature below, I certify to each of the following: I am the property owner or authorized agent 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 building c representatives of Cupertino to enter the above -id ntified property for inspection purposes. Date: 7 7 7 / -2c/ 17 Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER -THF -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 ❑ PLANNING PLAN REVIEW _ 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 El MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST: JOB ADDRESS: 7670 BF PLAN.D CT Cuetluflyo PERMIT # 7 OWNER'S NAME: j(Et4 n!E 1 (4 NO PHONE # U06 00-4058 GENERAL CONTRACTOR: SERh1 PR UD 14oN BUSINESS LICENSE # 4 O ©416 3 .ADDRESS: -107 5,, N0106913 DR, CITY/ZIPCODE:,3C0 T TS VOL jr4q5066 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork UL-)t4 BUIL DER S 0041, ,3 Cement Finishing Electrical PR to H04 aa b -6R S Excavation Fencing Flooring / Carpeting PA u D 146 f4 ba 1 LD&A S q 00 4/46 Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper FSR (A'D)l 0 N &U1 I DC -R5 * 0 ® 416 Paving Plastering R u DHoN 614 1 LI>EKS o /( Plumbing R �� 0 UI Z D ER S 400416 Roofing Septic Tank Sheet Metal Sheet Rock R U I' 4(3 N 81mCRs *00416 Tile p9al) 14 0/y 5uaDr-95 5t 00 416 Owner / Contractor Signature '?/7 42017 Date