Loading...
B-2017-1158CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1158 21377 KRZICH PL CUPERTINO, CA 95014-4942 (362 05 035) HOME DEPOT U S A INC ATLANTA, GA 30339 OWNER'S NAME: FISHBEIN JOHN R AND SHELLY DATE ISSUED: 07/18/2017 OWNER'S PHONE: 408-515-2810 PHONE NO: (770) 433-8211 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B: C-39: C-13: C-17 Lic. #602331 Contractor HOME DEPOT U S A INC Date 09/30/2018 X BLDG _ELECT _PLUMB — MECH JX 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: BLOW-IN INSULATION (1,064 SF) - ATTIC I hereby affirm under penalty of perjury one of the following two 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 erformance of the work for which this permit is issued. 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 c rtify 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 Signature Date 7/18/2017 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. 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. 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. Date 7/18/2017 Sq. Ft Floor Area: evaluation: $1900.00 APN Number: Occupancy Type: 36205 035 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby A, ey nde Date: 07/18/2017 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. Signature of Applicant: Date: 7/18/2017 ALL ROOF COVERINGS 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: Z11 8/2017 L;�MING AGENCY I hereby affirm that there ' ending 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 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(CDCu�.pertino.org 201 %- / PFRRED ❑ NEW CONSTRUCTION ElADDITION ALTERATION/TI ElREVISION/DEORIGINAL PERMIT # ►J PROJECT ADDRESSJ [ APN # D OWNER NAME © � � r ' 1 `Z PHONE 5. 5 'Z-(2' 0 EMAIL STREET ADDRESS 2- 1 2 7 7 � � r�G � F7 I / ^ � Q �O / � j CITY,<Lt) FAX ?CjZ1-71 �� J / CONTACT NAME JEFFJRAIN/EY PHONE510-427-4260 E-MAILJEFFREY.RAINEY@ATT.NET STREET ADDRESS 1069 EDGEMERE LANE CITYZIP ZIP HAYWARD, CA 94545 F'X 510-783-1041 11 OWNER ❑ OWNER -BUILDER 11 OWNER AGENT ❑ CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # 403136 602331 B,C39,C13,C17 COMPANY NAME E-MAIL FAX HOME DEPOT USA 510-357-3750 STREET ADDRESS CITY, STATE, ZIP PHONE 2456 VERNA COURT SAN LEANDRO,CA 94577 510-877-4550 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 316,1) -7 J S. F- . ,l s u /-'T t C), EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES 2— 1 USE IYI'E 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 # DWELLING UNITS: 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 REC B TOT VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO `l 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 h/ave read this application and the information I have provided is correct. I have read the Description offWW .is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize represe Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: _Date: S U2P!5NIENORMATIO Q PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: A y for de Ion permit for existing building(s). Demolition permit is prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ElSTANDARD 11PUBLIC 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 BldgApp2011.doc revised 06/21/11