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B-2017-1261CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1261 11234 CATALINA CT CUPERTINO, CA 9501411737 (356 21 042) JOHN SULLIVAN CONSTRUCTION. INC CAMPBELL, CA 95009 OWNER'S NAME: PALANKI RAVI AND NAGARKARARATI RAVINDRA T DATE ISSUED: 08/01/2017 OWNER'S PHONE: 619-241-6884 PHONE NO: (408) 247-2147 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class,B Lic. #453736 Contractor JOHN SULLIVAN CONSTRUCTION INC Date 07/31/2019 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: 1 ST FLOOR MASTER BEDROOM AND HALLWAY BATHROOMS I hereby affirm under penalty of perjury one of the following two declarations: REMODEL (108 S.F.) 1. I have and will maintain acertificate 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. have and will maintain Worker's Compensation Insurance, as provided for by kI Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $30000.00 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'construction, and hereby authorize 356 21 042 representatives .ofthis 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 applican understands and will comply with all non -point source regulations pert a Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. nature Date 8111201.7 Issued by: Abby Ayende UEL CL Date: 08/01/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the_ following two reason's: RE -ROOFS: . All roofs shall be inspected prior to any roofing material being installed. If a roof is t: I, as'm6er 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) f2i I, as, owner ofthe property, am exclusively contracting with licensed Signature of Applicant: contractors toconstruct the project (Sec.7044, Business & Professions Code). Date: 8/1/2017 'I hereby affirm under penalty of perjury one of the following three declarations: and Consent for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t'. I have will maintain a Certificate of to self -insure 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 Section 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 _ i.. ' P issued. miff maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the i , s, I c y e erformance of the work for which this permit is issued, I that the p Health & Safety Code, Section 25532(a) should Istore or handle hazardous 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 11 ,1 , i Worker's Compensation laws; of California. If, after making this certificate of 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, exemption, I become subject;to the Worker's Compensation provisions of the the Health & Safety Code, Sectio s 5505, 25533, and 25534. Labor Code,'I'tnust forthwith, comply with such provisions or this permit shall be deemed revoked 'o wner or authorized agent: APPLICANT CERTIFICATION Date: $/1/2017 I certify that I have read', this application and state that the above information is CONSTRUCTION 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,, ah, djhereby 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 savie indemnify and keep ha6less 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'thi permit. Additionally, the applicant understands andwill 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 8/1/2017 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(a)-cupertino.org I-Wll- 1`2&J B ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROTECT ADDRESSg I �� Lf 65t, � �� /` APN # 3 p rO (-f 2 - OWNER NAME � ` PHONE �P I� EMAIL STREETADDRESS 'A i `r �1 CITY, STATE, ZIP :-3 W CONTACT NAME S ! I. fi CGy �I k PHOZ(o " 2i (- Y Z �� E /` t> n k q& S J J G? l ��' 1 (®" / 7J ( kc: STREET ADDRESS G� 0P1L CITY STATE, ZIP b�c.I.� �0�� FAX ❑ OWNER ❑ OWNER -BUILDER ❑. OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSE ` NUMBER LICENSE TYPE BUS. LIC # lfS3 734 lS co2,74 _-?a! COMPANY NAME ._E-MAIL ZJ c(,'a/Y(0� '� C;.e FAX STREET ADDRESS t%v Q}1� {/J�Q CITY, STATE, ZIP K Jo'r (a �� (� P�� t�f i� C/ ARCHITECT/ENGINEER NAM LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 2_ Z EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. 7SQ.FT. VALUATION ($) EG / AREA/��' NEW FLOOR C AREA !0 0 DEMO AREA A TNETAREA Q oco BATHROOM KITCHEN OTHER REMODEL AREA. REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY OYES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY i h a TOTAL VALUATION': PLANNINGAPPL# ONO PLANNING APPROVAL LETTER EICHLER.HOME? ONO ' ^, 2 fid, •�� By my signature below, I certify to each of the following: I am the property owner or authorized agent lo act onkhe 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 uil ing cons cf . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. . Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED ` `, k pLAN CHECK?TYPE , O OVER THE ❑t BUILDING New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building COUNTER t ,1 PLAN REVIEWµ 3 permit for new building. ❑EarREss n ❑ rLA NIYING PLAN REVIEW � � � _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD' r ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ` v "El LARGE a d FHtE ..... DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MAaox s ❑" SANITARY SEWERDIS�RICT submittal of Building Permit application. z a e k 41 * ❑ENVHtONiVIENTAI IIEALTH,+.,> B1dgApp_2011.docrevised 06121/11