B-2017-1297CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1297
18590 RALYA CT CUPERTINO, CA 95014-3824 (375 25 017)
HOME DEPOT U S A
INC
ATLANTA, GA 30339
OWNER'S NAME: JONES MARGARET B TRUSTEE
DATE ISSUED: 08/07/2017
OWNER'S PHONE: 626-372-1492
PHONE NO: (770) 433-8211
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class l Lie. #802331
Contractor HOME DEPOT U S A INC Date 09/30/2018
X BLDG —ELECT _ PLUMB
MICH 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:
REPLACE WINDOWS (6) LIKE FOR LIKE' TO MEET EGRESS
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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.
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
Sq. Ft Floor Area:
Valuation: $4470.00
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
375 25 017
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.
Signatur' Date 08/7/2017
Issued by: Kim Dunb54 ar
Date: 08/07/2017
I hereby affirm that I am exempt 'from'the Contractor's License Law for one of the
RE-ROOFS:,
following two reasons: i
All roofs shall be inspected prior to any roofing materialbeing installed. If a roof is
r. 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 iwork„ 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`cons tract the project (Sec.7044, Business & Professions Code).
Date: o8 201
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. I have and will maintain, aCerdfrcate 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
I I '
Section 3700 of the Labor,Code, for the performance of the work for which this
California Health & Safe Code, Sections 25505, 25533, and 25534. I will
Safety
permit is issued. ;, j
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that m the' performance of the work for which this permit is issued, I
Health &Safety Code, Section 25532(a) should I store 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
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 l ecome,subjeet 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.
�J
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 08/7/2017
I certify that I have read this application and state that the above information isUCTIO
LE G A Y
correct. I agree to comply with all city and'county ordinances and state laws
I hereby affirm th6f6ere is a constructs len ' gency for the performance
relating to building constru8tion,;6cilhereby authorize representatives of this city
of work's for which this permit is issue ec. 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-paint 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 08M2017
Professional
CUPERTIINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 •building@cu ertin� o.org.-, � �!�
[71NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10 '�� I ( �
APN# � �r^ 2—
OWNER NAME �j7
P r � 7Z - 7 43 -z-
EMAIL
STREETADDRESS 1' / IO ^ I ` A ��-
CITY,� J� ��TE, ZIP (,J� 0y c OI , /
/ 7
FAX
CONTACT NAME JEFF RAINEY
PHONE 510-427-42 60
EMA�"JEFFREY.RAINEY@ATT.NET
STREETADDRESS' 1069 EDGEMERE LANE
CITY, STATE, ZIP HAYWARD, CA 94545
FAX 510-783-1041
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
403136
602331
B,C39,C13,C17
COMPANY NAME
E -MAH,
FAX
HOME DEPOT USA
510-357-3750
STREET ADDRESS
CITY, STATE, ZIP
PHONE
2456 VERNA COURT
SAN LEANDRO,CA 94577
510-877-4550
ARCHrrECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAII
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK A 11 ) I
i
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
USE TYPE
OCC.
SQ.FT.
I'
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
.
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODELAREA REMODEL AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
ISA SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEINGADDED? []NO
ADDITION? []NO
PRE -APPLICATION ❑ YES - IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
,; R D d V UAT N:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
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 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 building cons authoriz epresentatives of Cupertino to enter the above -identified f or inspection purposes.
(property'
Signature of Applicant/Agent:. Date:
SUPPLEMEN IAL INFORMATI D
PLANCHECKTYPE -
ROUTING;SLIP
❑ OVER THE COUNTER
❑ BUII DIIVG PLAN REVIEW
_ New SFD or Multifamily dwellings: Alply for demolition permit for
existing building(s). 'Demolition permit is required prior to issuance of building
permit for new building.
11 'ExeRESs
E14LANNINGPLANREVIEW",
_ 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'
FlltELDEPT
of Planning Approval Letter or Meeting with Planning prior to
'submittal
❑
❑
submittal of Building Permit application.
MAJOR
SANrTARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06121111