B-2017-1166CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1166
20073 NORTHCREST SQ CUPERTINO, CA 95014-0509 (316 38 072)
THRASHER TERMITE
PEST CONTROL
FARLEY RD WEST
LOS GATOS
OWNER'S NAME: FRESCURA BERT L TRUSTEE
DATE ISSUED: 07/19/2017
OWNER'S PHONE: 408-206-0775
PHONE NO: 408-354-9944
License Class Lic. #
Contractor THRASHER TERMITE PEST CONTROL Date
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.
z. 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 regulatio per the Cupertino M icipal Code, Section 9.18.
Sign ure 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:
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
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
DECK REPAIR - REMOVE & REPLACE LIKE FOR LIKE
Sq. Ft Floor Area: I Valuation: $8740.00
APN Number: Occupancy Type:
316 38 072
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
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.
sale (Sec.7044, Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed Signature ofAppl
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 07/19/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 pertnit 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.
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 C ertino Municipal Cgde, Chapter 9.12 and
the Health & Safety Code ections 255 , and 255 .
Owner or authorize gent:
Date: 07/19/2017
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ALTERAT) N / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS O /jT -1i"
OWNER NAME � W e- ` PHONE ^ 6 6 r 6 77 �;L'/A)M I LLEP n6�TD Q� a
I ` �/f
STREET ADDRESS
CITY, Sy,IYTE, Lk / ,�,�,dM0 C /ti j
lj10��V
FAX
CONTACT NAME
`f7V�4 lav ,C
PHIO../NEV ?G�/ 71
(]Ck
E-------
STREET ADDRESS n ��-�/-'JCC �l CITY, STATE, ZIP - �j�yq, �/�
t�y�y^
FAX
' 1'❑uOWNER
❑ OWNER ❑ OWNER -BUILDER AGENT ❑GVCONTRACTOR ❑ CONTRACTOR AGENT ❑l-.BARRCCHITE`CT El ENGINEER ❑ DEVELOPER ❑ TENANT
CONT - CTOR NAME � I A LIC NSE NUMBER _
C
LICENSE TY�PEI�
/ I/�
'C�
BUS. LIC # (
- `
p
�C
L
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS �, l
CITY, STATE, IP� ^, ,A Cjy
�`�' ,�C/
PH NE 5
`
ARCHITECT/ENGIN EER NAME
LICENSENUMBER I
BUS. LIC#
COMPANY NAME
E-MAIL
FAX
STREET ADDR
CITY, STATE, LIP
PHONE
DESCRIPTION OF
� .. r ,I� I
e&m' U
�' �j V f `�(/�'1
/WORK eA 'VI
2 -1 C ��-
EXISTING USE
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,U7
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UMTS:
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
VED Y: A TI
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? E] NO
f0T
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 prov' ed 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 it g construction. I auth ize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Age Date: �� [
SUPPLE AL NFORMA QUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ HUILDINGPLANREVIEW
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
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BIdgApp_2011.doc revised 06/21/11