B-2017-0761CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0761
10460 SERRA ST CUPERTINO, CA 95014-6581 (342 59 012)
LOAYZA'S
LANDSCAPING
POOLS & SPAS INC
SAN JOSE, CA 95160
OWNER'S NAME: STEVENS TIMOTHY J TRUSTEE & ET AL
DATE ISSUED: 07/17/2017
OWNER'S PHONE: 650-224-2720
PHONE NO: (408) 297-5555
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 13 Lic. #546014
Contractor LOAYZA'S LANDSCAPING POOLS & SPAS INC Date 11/30/2018
x BLDG X ELECT _PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
I hereby affirm that 1 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:
DETACHED WOOD GAZEBO (300 S.F.) WITH (6) LIGHTS, (1) FAN,
I hereby affirm under penalty of perjury one of the following two declarations:
(1) OUTLET; INSTALL (12) LANDSCAPE LIGHTS.
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
of the work for which this permit is issued.
2. e4erformance
havc and will maintain Worker's Compensation Insurance, as provided for by
Sion 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $22000.00
permit is issued.
.APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
342 59 012
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save in mnify and keep harmless the
City of Cupertino against liabilities, judg ts, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequoce of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands add will comply with all non-point
source regulations per the Cupertino vlllnicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatur % Date 7/17/2017
Issued by: Abby Avende
L. /��
OW R-BTJIfDFR DECLARATION
Date: 07/17/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. 1, 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
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 7/17/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
x. 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
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534, l will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9. and the
a. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) sh Id I storeor hatidle zardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equip nt or devices which It hazardous
air contaminants as defined by the Bay a Air Quality Man em t District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cup i ut;icipa1 o a r .12. and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, e 2 a
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 7/17/2017
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
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 upon 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 with all non-point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 7/17/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
C (408) 777-3228 •FAX (408) 777-3333 • building(a)cupertino.org
URERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # C
PROJECT ADDRESS G' `Y
APN #�
OWNER NAME E-MAIL
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ADDRESS ,I
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CONTACT NAME . �PH
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❑ OWNER ❑OWNER-BUIDER ❑ OWNER AGENT PCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGL\TER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ---
LICENSE NUMBER
LIC �'SE TYPE
BUS. LIC
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COMPANY N E,Aa
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FAX
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STREET ADD SS CITY, Sr ziP
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PHONE
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ARCHITECT/ENGWEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHON
DESCRIPTION OF WORK *e�/{/ /` ae) �� /� sae
/i
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
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 DECK/PORCH AREA
GARAGE AREA: DETACH
ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY YES
BEWGADDED? ONO
ADDITION? []NO
PRE-APPLICATION ❑ YES IF YES, PROVIDE COP,t`.-bff
IS THE BLDG AN -"- YES
LUOTAL VALUATION:
PLANNING APDL # ❑ NO PLANNING APPROI
EICHLER HOME? ❑
By my signature below, I certify to each.4 e 1 e pro erty o thorized agent to act on the property owner's behalf. I have read this
application and the information I have p vi e e read a 'p ' o o0eand verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b iId' o auth p se tiv of pertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: f ` Date:- l .
SUPPLEMEN TION D,
;. PLAN CHECK TWE
'- ROUTING SLIP
�._�.
New SFD or Multifamily dweiings: Apply for ed mollhon permit for
❑ OVER-THE-COUNTER
❑ BUn.DLVGPLANREviEW
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
❑ NIAJOR
❑ SANITARY SETA ER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06121111
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