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B-2017-1340CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1340 19745 AUBURN DR CUPERTINO, CA 95014-2413 (316 32 007) CUSTOM PAINTING AND CONSTRUCTION TRACY, CA 95376 OWNER'S NAME: SEITER KARL H AND JUNE L TRUSTEE DATE ISSUED: 08/14/2017 OWNER'S PHONE: 408-505-9578 PHONE NO: (408) 460-6251 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class j3 Lie. #875226' Contractor CUSTOM PAINTING AND CONSTRUCTION Date 03/31/2018 X BLDG X ELECT X 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: KITCHEN REMODEL (209 SF); CHANGE PANEL (200 AMP); NEW I hereby affirm under penalty of perjury one of the following two declarations: GAS LINE TO STOVE m. 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 40 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $27500.00 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 316 32 007 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. SignatLie Date 08/14/2014 Issued by: Kim Dunbar Iry OWNER -BUILDER DECLARATION Date: 08/14/2017 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 t. 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 isnot intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 08/14/2014 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A" OR BETTER m. 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. 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 Q1_1_ California Health & Safety Code, Sections 25505, 25533, and 25534. I will the Cupertino Municipal Code, Chapter 9.12 and issued. maintain compliance with the 31 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 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 exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code; Sections 25505, 25533, and 25534. Labor Code, I' must foitliwith'comply with such provisions or this permit shall be deemed revoked. 1. Owner or authorized agen Awk., ` APPLICANT CERTIFICATION Date: 08/14/2014I I certify that I have read this application and state that the above information is CONS CTION LENDING AGENCY correct. I agree to comply with: ail,clty;and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, land 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 alll non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 918. 1 understand my plans shall be used as public records. i Signatur.E? r�„� ti'V;<►-- Date 08/14/2014 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO I (408) 777-3228 • FAX (408) 777-3333 • building(d)_cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION © ALTERATION / TI ❑ REVISION / DEFE D ORIGINAL PERMIT # PRO ECT ADD S APN J ~oo 1WNER N ME PHOF -MAIL S ET D STATT�AO - C FAX J� L., NTACT NAME •" P7001 MAIL ST ADDRESSY, STATE, ZIP C e ❑ OWNER - ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT �ON RACTORNAMIG' ) SE�ITJMBE 2LICE7NSET Eef ` COMPANY NAME n � �� EMAIL n �j �yd•� � FAX G , ak (�.r-6��V��-i�cS er Sacv� c u I�W�C e �V11� S T ADDRESS TY, STATE, ZIP ICU ���% PHO ufo qbo ate) r� c ci, ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE D SCRIPTION OF w0 EX STING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEWFLOOR DEMO TOTAL AREA .� AREA d .� AREA L) r/ \ 1 NEr AREA ^ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA/ V� / REMODEL AREA PORCH AREA DECK AREA. TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH ATTACH I # DWE LING UNTTS: IS A SECOND tJNIT ❑ YES SECOND STORY ❑ YES /f BEING ADDED? FANO ADDITION? I�NO PRE -_APPLICATION ❑ YES IIF YES, PROVIDE COPY OF IS THE BLDG AN El YES RE D r 1� x u L VALUATT� TTAA PLANNING APPL # jy}NO .PLANNINGAPPROVALLETTER EICHLERHOME? ,q NO i ' 500r- 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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: �� Date: L SUPPLEMENTAL INFORMATION REQUIRED i,•;s.PLAN;CHECKTXPE New SFD or Multifamily dwellings: Apply for demolition permit forOUN ❑ THE ❑ existing building(s). Demolition permit is required prior to issuance of building OVER CTER BUILDING PLAN REVIEW _ permit for new building r t e fE ❑ EaPREs"s � t F ❑ PLANNINGPLAN REVIEW l ` ' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure "El"' ❑ _ form if any Hazardous Materials are being used as part of this project. r rusilc woRKs v LARGEx1� � ❑ FIRE DEPT" "" ` _ Copy of Planning Approval Letter or Meeting with Planning prior to t MAIOR ❑ sANITARY SEwERDISTRICT submittal of Building Permit application. ' BldgApp_2011.doc revised 06121/11 as