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B-2017-1396rA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1396 7629 NORMANDY WAY CUPERTINO, CA 95014-5252 (366 11 161) KEPPEL CONSTRUCTION SAN JOSE, CA 95128 OWNER'S NAME: INCE CLARK S AND JACQUELINE E TRUSTEE DATE ISSUED: 08/22/2017 OWNER'S PHONE: 408-257-2046 PHONE NO: (408) 248-2330 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #529Z89 Contractor KEPPEL CONSTRUCTION Date 05/31/2018 X BLDG —ELECT —PLUMB I her ' eby 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: FIRST FLOOR BATHROOM HALLWAY REMODEL (80 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. 14110&ave and will maintain Worker's Compensation Insurance, as provided for by 001, 1 Section 3100 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $16000.00 pern* is issue& APPLICANTCERTIFICATION I certify that I'h6ve read this'application and state that the above information is co�rect. I agree to comply with all city and county ordinances APN Number: Occupancy 1�ype: and state laws relating to building construction, and hereby authorize 36611161- represe'ritatives; of this cliy 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 WITIIINI 180 DAYS OF PERMIT ISSUANCE OR Additional ly,,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. a, nkoatru6q Date 8/22/2017 Issued by: Abby Ayende Date: 08/22/2017 lhereb�.:a iirm ih.tJ a. 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 ii� :I ias o I "er ofthe liropert y, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for I . co s , ation, will do the work, and the stnicture is not intended or offered for inspection. rty, am exclusively contracting with licensed Signature ofApplicant. on� a the project (Sec.7044, Business & Professions Code). Date: 8/22/2017 I hereby-affirm,"der,�enal�y of p6rjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "All OR BETTER 1. 1 hay� iind will maintain a:, Certificate of Consent to self -insure for Worker's Compe4sation, as provide d for by Section 3700 of the Labor Code, for the perf6r�iaoce of the w6rk for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 1 haveand Will mairrt�in Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Secti'94 3700 of the Llboi, Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 wHI perrhii is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3'.1 �I ceft*that in the,p �fbrmance of the work for which this peimit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall n"�i employ 'any "person 'in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 'V�ori4!s Compensation liws ofCalifomia. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management,Distriet I exemption, I become subject to the Worker's Compensation of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Safety Code, provisions L ab -de, I muit forthwith comply with such provisions or this permit shall. be deemed revok6d. t � : the Health & Sections 25505, 25533, and 25534. er or authorized agent: Rc_� . , � APPLICANT CERTIFICATION Date: 8/2212017 I certify that I have read'this,appli6ation and state that the above information is CONSTRUCTION LENDING AGENC correct. I agree "to comply withall city.and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relatingto building constructldh, a�d hereby authorize representatives of this city Of work's for which this permit is issued (Sed. 3097, Civ C.) to enter upon the above rn6koned property for inspection purposes. (We) agree Lender's Name to save indemnify and ikeep h6rmlbss the City of Cupertino against liabilities, , judgments, cost. i, and:expans6s'w'hich may accrue against said City in Lender's Address consequence of the grant!66 6f this permit Additionally, the applicant understands and will,comply�l ith all hon -point source regulations per the Cupertino Municipal ARCEUMECTIS DECLARATION Code, Section l'understand my plans shall be used as public records. Licensed Signatu�eAkjv Date 8/22/201 Z Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building.@cupertino.or PEMIT #B - 101 CUPERTINO REV # DEF # I—I NTFW c'c)T�TSTRT Tc'TTc)NT I—I AT)T)TTTONT 12AT.TFR ATInN 7 T T 7 MT:P 7 RE -ROOF 7 SWIMMING POOL/SPA PROJECT ADDRESS 7L. 4 Y APN # OWNERNAME PHONE4CJ_—& i as'-W, ` EMAIL STREET ADDRESS Z �Dri�2 GJ CITY, STATE, ZIP �176k2T1� ONTR% %%�r,elc CC�nJAC�/T//O��R NAME ❑ OWNERR-BUILDER CO/M�PyA/N�Y 0 x ` • RAAMME p� IC�� W�U��i j G� LICENSE UMB%ERR LICENSE �� [ V� 11 TYPE ��, 533© SS' /t/L/ V/r/�0' CTTYTA Z1I' c �%�/LrfJ f E-MAILS PHO B.U.S. LIC # ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT CONTRA R AGENT El ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAMfp E-MAIL STIMETADDRESS r E / 1// �` Qr vy�/ 1 <i- V P CITY, STATE, Z P �Q / NF DECRIPTONE07 A24� SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) EXISTING USE EXISTING SF 'NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF REMODEL BATHROOM SF REMODEL KITCHEN SF REMODELOTHR SF GARAGE ❑ ATTACHED SF ❑ DETACHED j ISING El YES SPRINKLERS El NO FIRE EICHLER ❑❑ NO SECOND STORY ADDITION El YES ❑ NO DWELLING SECOND DWELLING t3 YES [3 ATTACHED ❑ DETACHED OTHER UNTTS ll UNIT ADDTTON: ❑ NO S F POOLS E] FIBERGLASS ❑ VINYL -LINED [IGUNITE E] PREFABRICATED . POOL - SF SPA - SF SPA ATTACHED ❑ YES N NO TOTAL - SF Commercial or Multi -Family Buildin¢s with Public SToimming Pools requires Department o(Envirmmtental Heath armroval RE IVED BY: � I e _ p „ V VY�JC TOTAL VALUATION: 1 RE -ROOF EXISTING ROOF TYPE; ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ 1. WOOD SHINbLESEJ TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO El YES IPNO I # OFLAYERS PLYWOOD ❑'�z [-13/8" PLYWOOD THICKNESS E]5/8" OTHER TYPE: ❑OSB El CDX OTHER PITCH:' I '12 ROOF CLASS 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 itlis accurate. I agree to comply with all applicable locale ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified: property, for ins ec 'on p poses.. I ac . owledge a d authorize all information contained on flus application form to be made available for public record. �I Signature of Applicant/Agent; i Date: SUPPLEMENTAL INFORMATION.REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building per for all new construction. *Comercial Buildings:; Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used ae part of this project. m *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.I doc revised 08/01/17 i i