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B-2017-1343CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1343 10640 TUGGLE PL CUPERTINO, CA 95014-3628 (375 34 067) ROCHNS COMPANY SAN JOSE, CA 95125 OWNER'S NAME: SINGH RANJANA TRUSTEE DATE ISSUED: 08/14/2017 OWNER'S PHONE: 408-813-8530 PHONE NO: (408)593-7405 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B. C20 Lic. #$12112 Contractor ROCHNS COMPANY Date 02/28/2019 X BLDG X ELECT _PLUMB MECH X RESIDENTIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing —COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: (N) TEMPORARY POWER POLE (125 AMP) 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 10* ompensation, 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. Sq. Ft Floor Area: Valuation: $850.00 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 34 067 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 applica understands and will comply with all non -point gulations pe a Cupertino Muni a C , ction 9.18. slhnatw 180 DAYS FROM LAST CALLED INSPECTION. Date 8/14/2017 Issued by: Jasmine Archbold Date: 08/14/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 2. 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 work, 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 ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/14/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 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. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. 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 air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino unicipal Code, Ch Wer 9.12 and exemption, I become subject to the Worker's Compensation provisions of the fte Health &Safety Code, Secti 25505,�L: . Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. O r authorized agent. APPLICANT CERTIFICATION 8 14 20 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, and 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 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. Signature Date 8/14/2017 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE'AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - building@cupertino.org PEMIT #B -b261:1 - CUPERTINO hl NEW CONSTRUCTION I—I ADDITION I—I ALTERATION I—I T.I. MEP F] RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS � / 5 r OWNER r- PHONE E-MAIL STREET AbDR69 CITY, S ATE, ZIP CONTRACTOR NAME ER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE s 1 02 STRtET ADDRESS' I Z-1 q J )6"(Fe TATE, ZIP E- ARI I PHONE BUS. LIC # J_ - 3- S Z� ❑ ARCHITECT [IOW ❑ OWNER1e4_ AGENT CO CIORAGENT❑ ENGINEER Ll ElfVELOPER ❑ TENANT CONTACT NAME EMAIL STREETADDRESS CITY STATE, ZIP PHONE DECRII'TON i NGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) 'EXISTING USE I EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED EXLSING ❑ YES EICHLER ❑ YES SECOND STORY ADDITION ❑ YES FIRE SPRINKLERS ❑ NO ❑ NO ❑ NO DWELLING []YES ❑ATTACHED❑DETACHED OTHER ISECONDDWELLING UNITS # UNIT ADDITON: ❑ NO S F POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF LVED BY: TOTAL VALUATION: Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath npproval RE -ROOF EXISTING ROOF TYPE; E] BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES ❑ WOOD SHINGLES ❑TILE OTHER (SPE ) REMOVE /REPLACE ❑ NO IF NO I PLYWOOD El 'h" ❑ 3/8" PLYWOOD TYPE: PTTCH: ROOF CLASS I ❑ YES # OF LAYERS THICKNESS [:15/8- OTHER ❑ OSB ❑ CDX OTHER :12 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 hav provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances state la lating to bui struction. I authorize representatives of Cupertino to enter the above -identified property for inspec ' purpos I cknowled orize all information contained on this application form to be made available for public reco Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily 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