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B-2017-1381a CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1381 10545 MIRA VISTA AVE CUPERTINO, CA 95014-2707 (357 05 002) SST CONSTRUCTION LLC RANCHO CORDOVA, CA 95742 OWNER'S NAME: MILLER MATTHEW D AND STEPHANIE S TRUSTEE DATE ISSUED: 08/18/2017 OWNER'S PHONE: 650-799-2620 PHONE NO: (916) 879-5984 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 13: C-46: C-10 Lic. #1009107 Contractor SST CONSTRUCTION LLC Date 11/30/2017 X BLDG X ELECT _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: INSTALL (2) BATTERY BACK UP (27 KW); (l) LOAD CENTER (200 I hereby affirm under penalty of perjury one of the following two declarations: AMPS) 1. I have and will maintain a certificate of consent to self -insure for Worker's OpIrT pensation, 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: $18000.00 permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 357 05 002 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. lgnature � - . Date 8/18/2017 Issued by: Abby Xende Date: 08/18/2017 OWNER -BUILDER DECLARATION I hereby affirm that,I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. 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 is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/18/2017 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 z. 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. I 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 Municipal Code, Chapter 9.12 and exemption, I become subject 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 l; J be deemed revoked, go Mner or authorized agent: APPLICANT CERTIFICATION Date: 8/18/2017 1 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 indt;mnify and keep harmless the City of Cupertino against liabilities, judgment$,, 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. Licensed Signature Date 8/18/2017 Professional CUPER'1 INO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255- (408) 5014-3255(408) 777-3228 • FAX (408) 777-3333 • building(Wcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ Ti ❑ RAVTSinN /T)FFARRFI) nRInIVAI I)PDrATTA PROJECT ADDRESS ApN # 2•c� . �S j.,/�� OWNER NAME o�J//✓I�rn,r/ ��Y PHONE� �(J E-MAIL STREET ADDRESS CITY. AA) & 9�� II ±& FAk CONTACT NAME/!/J�r PHt`_ J -✓J Zrf E M&/ �li��X/K-' �XJ ' STREETA /R, I /v✓!.J/"IJ Ili /J C p (_i FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑'CONTRACTOR /�4ONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT �li ,�J o. CONTRACTO�I�A LICE �gFiy1�B$i2/1 7(EJMGA%IL�(� LI S, �/D IIn OJ COMPA �..3//GLT��/'��(�(C� FAX STREET S / 22 L 'C/, CI II'7�/Y� PH ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Yv Iwo�i Lari IJGY VILI Z�; a0A 25) EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA Q W FLOOR AR DEMO AREA TOTAL NET AREA BATHROOM KITCHEN. OTHER ,REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AR GARAGE AREA: TACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT SECOND STORY BEING ADDED' NO ADDITION? E]NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? []NO RECE . I)'B= -.: TO L VALUATION: By my signature below, I certify to each of the following: I am th roperty owner or authorized agent to ac on the operty owner's behalf I have read this application and the information I have provided is corre Ila ead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state.laws relating to building const tion. I at on representatives of Cupertino to enter the abve-iden ified property for inspection purposes. Signature of Applicant/Agent: Date:�� SUPPLEMENT ATION QUIRE pLAN,CAECKTYPE ROUTI�IG,SLIP, ❑-` OVER THE COUNTI R ❑ $i1ILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing buiiding(s). Demolition permit is required prior to issuance of building permit for new building-' EXPRt s's ❑ pL`ANNWG PLANRi VIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D' STANDARD ❑ P,UBLIC WORKS `form if any Hazardous Materials are being used as part of this project. LARGE''a + ; ❑- Copy of Planning Approval Letter or Meeting with Planning prior to t FIREDEI'f, l: _ submittal of Building Permit application. ❑' MAJOR - ❑ SAiVITARX SEWER DISTRICT ❑ EjHVIRONIYlENTAL HEALTH , , B14APP_2011.doc revised 66/21/11 Abby Ayende 08/18/17 08/18/17 B-2017-1381 Abby Ayende Abby Ayende 08/18/17 Abby Ayende 08/18/17 Abby Ayende 08/18/17 Abby Ayende 08/18/17 Abby Ayende 08/18/17