B-2017-0673 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: • CONTRACTOR: PERMIT NO:B-2017-0673 '
19161 LOREE AVE CUPERTINO,CA 95014-3539(375 07 031) JEFF MAGGI
CONSTRUCTION INC '
SANTA CLARA,CA
95050
OWNER'S NAME: OLEARY TIMOTHY M AND CARRIE L TRUSTEE DATE ISSUED:07/25/2017
OWNER'S PHONE:408-209-3104 PHONE NO:(408)210-7753
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#788338
Contractor JEFF MAGGI CONSTRUCTION INC Date 11/30/2018 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:
' FIRST FLOOR NEW-LIVING RM(186 SF)BEDROOM(213 SF)
I hereby affirm under penalty of perjury one of the following two declarations: ENTRY WAY(61 SF)REAR PORCH,(70 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's FIRST FLOOR REMODEL-KITCHEN(186 SF);BEDROOM(98 SF)
Compensation,as provided for by Section 3700 of the Labor Code,for the FRONT PORCH(26 SF)
performance-of the work for which this permit is issued. ' REV#1-RE-ROOF;TEAR-OFF;INSTALL OSB(N);COMP SHINGLE
ik 1100
(2. I have and will maintain Worker's Compensation Insurance,as provided.for by SQ)
Section 3700 of the Labor Code,for the performance of the work for which this _
permit is issued. Sq.Ft Floor Area:464 Valuation:$86000.00 ,
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 375 07 031 R-3(Custom)
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-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.-
Signature 7 ` /Jti— Date 11-29-2017 Issued by:Kim Dunbar
Date:07/25/2017
. OWNER-BUILDER DECLARATION' •
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
i.- 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 SP inspection.
I sale(Sec.7044,Business&Professions Code) //////
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: i'/1#77-Z-1,,,_
contractors to construct the project(Sec.7044,Business&Professions Code). Date: 11-29-2017 `/ ,
1
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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
2.' `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
Stiction 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
material. Additionally,should I use equipment or devices which emit hazardous
sli'all not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area,Air Quality Management.District I
• •Worker's Compensation laws of California. If,after making this certificate of 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 � i,
Owner or authorized agent: ' � �.,sr Y
APPLICANT CERTIFICATION Date: 11-29-2017 II
I certify that"l have read this application and state that the above information is CONSTRUCT Ni LENDING AGENCY
correct.I agree to.comply with all city and county ordinances and state laws I hereby affirm that there is a construction 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 upoh 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 withall non-point Source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.1'8. I understand my plans shall be used as,public records.
•
Licensed
Signature Date 11-29-2017 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0673
19161 LOREE AVE CUPERTINO, CA 95014-3539 (375 07 03 1)
JEFF MAGGI
CONSTRUCTION INC
SANTA CLARA, CA
95050
OWNER'S NAME: OLEARY TIMOTHY M AND CARRIE L TRUSTEE
DATE ISSUED: 07/25/2017
OWNER'S PHONE: 408-717-3105
PHONE NO: (408) 210-7753
LICENSED CONTRACTOR'S DELL. RATION
BUILDING PERMIT INFO:
License Class @ Lic. #Z88338
Contractor JEFF MAGGI CONSTRUCTION INC Date 11/30/2018
I1MB
X BLDG —ELECT —PLUME
—
MECH X RESIDENTIAL COMMERCIAL
T 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:
FIRST FLOOR NEW - LIVING RM (186 SF) BEDROOM (213 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
ENTRY WAY (61 SF) REAR PORCH (70 SF)
chave and will maiiitain a certificate of consent to self-insure for Worker's
FIRST FLOOR REMODEL -KITCHEN (186 SF) BEDROOM (98 SF)
ompensation, as provided for by Section 3700 of the Labor Code, for the
FRONT PORCH (26 SF)
performance of the work for which this permit is issued.
I'have and,will,maintain Worker's Coimpensation Insurance, as provided for by
'Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area: 464
Valuation: $86000.00
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
APN Number:
Occupancy Type;
and state laws relating to building con'struction,and hereby authorize
375 07 031
R-3 (Custom)
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-point
source reg ., lations per the Cupertino.Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signa,-a Date 07-25-2017
Issued by: Kim Dunbar
Date: 07/25/2017
DER DECLARATI
I hereby affirm that fain exempt, from the Contractor's License Law for one of the
RE-ROOFS:
following two 'reasons:;, i
Ali roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I; as owner!of the, propei3y,''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,wo'rk, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Busmas"s &'Professions Code)
2.' I; as owner iof the property, 'am exclusively contracting with licensed
Signature of Applicant:
contractors,to constiuet�the project (Sec.7044, Business & Professions Code).
Date: 07-25-2017
I hereby affirm undef penalty of perjury one of the following three declarations:
„ „
ALL ROOF COVERINGS TO BE CLASS A OR BETTER
1. I have and;whl mai&ain a Certificate'of Consent to self-insure for Worker's
Compensation, as;pfovl&d�for by Section 3700 of the Labor Code, for the
pe,formanee of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. Thave and will mamtaui Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of ilio Labor Code, forthe performance of the work for which this
California_ Health & Safety Code, Sections 25505, 25533, and 25534. I will
I i , ' I,
paraut is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. 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
1 „ :. i :1,;
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
I Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined b the Ba Area Air QualityManagement District I
exemption I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino. MunicipaCode, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor CodeLmust forthwithscomplywith such provisions or this permit shall
be, deemed revoked
Owner or authorized age
i
i APPi ICANT CERTIFICATION
Date: 07-25-2017
-
I certify that I have read this japplication and state that the above information is
O&STRU 0 LENDING AGENCY
correct. 1 agree to complyiwith all ;city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the ,performance
relating to building co'nstructi'on) and hereb' authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioneii property1or inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless,the. City of Cupertino against liabilities,
judgments;!costs, and expenses whicl ,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-poi'4sou' regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18'.' ' '
I understand my plans shall be used as public records.
Licensed
Signature Date 07-25-2017
Professional