B-2017-1338CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10424 STERLING BLVD CUPERTINO, CA 95014-3832 (375 24 003)
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OWNER'S NAME: MAGED ATTIA
OWNER'S PHONE: 714-222-4410
LICENSED CONTRACTOR'S DECLARATION
License Class C10 Lica#828903
Contractor M B ELECTRIC Date 12/31/2017
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.
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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
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
and state laws relating to building construction,, and hereby authorize
representatives of this city to enter upon•th'e 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.Cuperti cipal Code, Section 9.18,
I
SignatureU Date 08/14/2017
OWN�_-DE91'�ELARATTJON
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 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:
t. 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.
2. 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 inspectionpurposes. (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 08/14/2017
CONTRACTOR: PERMIT NO: B-2017-1338
M B ELECTRIC
SAN JOSE, CA 95122
ISSUED: 08/14/2017
NO: (408) 690-0108
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
TEMP POWER -POLE - (100 AMI')
Sq. Ft Floor Area: I Valuation: $600.00
APN Number: Occupancy Type:
375 24 003
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 08/14/2017
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 App]
Date: 08/14/2017
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, 2553 nd 25534.
Owner or authorized acient:,40
Date: 08/14/2017
I hereby affirm that there is a construction lending 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 2 Q
PEMIT #B - —=
(408) 777-3228 • building@cupertino.org
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
JAPN#
OWNER NAME PHONE
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STREET ADDRESS
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CONTRACTORNAME ❑ OWNER -BUILDER
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LICENSENUMBER
LICENSE TYPE
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STREET ADDRESS
CITY, STATE, ZIP
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❑ ARCHITECT ❑ OWNER ❑ OWNERAGENT�CONTRACTOR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
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DECRIPTON
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'PSINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXISTING SF
NEW FLOOR SF I
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
FIREEXISING YES
[I NO
YESSPRINKLERS
EICHLER 0 NO
YES
SECOND STORY ADDITION O NO
DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS # UNIT ADDITON: []NO S F
I
POOLS ❑ FIBERGLASS ❑ VINYULINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL -.SF
REC T L VALUATION:
Commercial or Multi-Famil u Buildings with Public Swimming Pools requires Department of Environmental Heath approval
42 n
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOO HINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NOI
IF NO
PLYWOOD ❑'h" ❑ 3/8"
PLYWOOD TYPE:
PITCH:
ROOF CLASS
E] YES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
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A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES
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 ins tion purposes. I acknowledge and authorize all information conta' ed on this application form
to be made available for publi record.
' i� 1
Signature of Applicant/Agent: Dat
Id
SUPPLEMENTAL INFORMATIO EQUIRE
*New SFD/Second Dwelling Units I y Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
BldgApp 2017.doc revised 08101117