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B-2017-1148
• CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1148 10449 COLBY AVE CUPERTINO,CA 95014-2421(316 29 016) SHERMAN ELECTRIC SUNNYVALE,CA ' 94086 OWNER'S NAME: SCHINDLER RONALD P AND ADA H TRUSTEE DATE ISSUED:07/18/2017 OWNER'S PHONE:408-505-8081 PHONE NO:(408)438-1078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#872944 Contractor SHERMAN ELECTRIC Date 02/28/2018 • 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: • ' UPGRADE PANEL(200 AMP)-SAME LOCATION 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 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. , Sq.Ft Floor Area: Valuation:$1200.00 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 316 29 016I representatives of this city toenterupon 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. . Signatu - .. .. • Date 08/30/2017 Issued by:Jasmine Archbold ,. Date:07/18/2017 OWNER-BUILDER DECLARATION • s I hereby affirm that I ani 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 1. 1,as'owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/30/2017 Thereby affirm funder penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r, 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will Cmain- permit is issued. tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the /�./ 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 i ur cipal Code,Chapter 9.12 and exemption,'I become subject to'the Worker's Compensation'provisions of the ' ' the Health&Safety code,Sectio ,>05,25533,and 25534. ' ' ` .. Labor Code,I.must forthwith comply with such provisions or this permit shall . .. . I • " 'be deemed revoked. • • � Owner or authorized agen .,,,f - APPLICANT CERTIFICATION - • Date:08/30/2017 . application and state that the above information is I herebyaffirm that there is a TION IO LENDING AGENCY I certifythat I have read this ` correct. to gree t o mply with all city and county ordinances and state lawslending agency for the performance ' relating g n,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,gran�'r his permit. Additionally,the applicant understands • • and will comply;with all f .hint source re. -tions per the Cupertino Municipal - . . . ARCHITECT'S DECLARATION ' ' Code,Section 9.18: I understand my plans shall be used as public records:. • Licensed Signature ; Date 08/30/2017 • Professional ' A r CjIffi=DICO 2 727Cagi. ‘'i I.°I MCP® TO : !- :._C 14 ' _C(4,104,AfPIA.).-0 - 1 1 . F Ron-1 80.-Cl.ifv:biA,...- .— 3.:,.-. ad .- _)2 et/0( • • R CAVOR) 40114 ; Z b I ri .-::.....:;:'...,....,,,z1::.i.,.....,Z,t,-,?.',MM.rrg-4%-.1.ttf. .. ..'*u-J....1.--Alk.TC;.:,#F-S56..1,1-WMO,.;;;',.fftiTM,77-WV:F.I_ST-A.;-Wirini..T.:;.51:.Sy.M, .7:_fpf5':.7.•:::.,",:l.5T...,"4.:,-,-fe'..q";.,:T4.?...,:: :".":f-,,,'•:'..' DT ? ' Rvsek\I i S.6Amr=“4.' ('.' ,. .;:-ii • ,)...., : . .- L; (40 4 I : 64,‘,:fk: 7,-.1-,.z, (..A.0.,.... Po t.)0A...ve)ciA44. 04.2-- ,::',,..., p., • A/04"0/ oZ2 0(..t 74,114/1 E 1 AcTe ic....e.-e 1 ( /.. ....TAfm...y.P 1 cl,0".. e ixd.°1410. "wig'&ittl.(D Is ti z tiv e. -4 iS . SA I 2. r)._,A4.1iite ) eco. it if. :-...'-,A w. ag.440od ki ,.. •; i •,-J 8 r.i'11444 4.A -/-,40-14. 40,.. 0.i.i.. t/ e $ 10,4 dext441, 1-4-6 . Pit. ki getkv-644-0,-, 14It- iesky ....s/Istsvme.v., '..a Ite.4ttta L *i 1.1 i 7 z4-cfq . ':..'I' — 1 / e,,....., .....-To ta :ars-ote ,, -ed.----Tagettriotisit:40g,..,.,.a.t.#4,74 .:...9.6007.4f,.:...„.. I, •. .•,:,-.•:,, • . .. ' v , 4_e) I .71 :!.., : , ,..,.• , . . . :..• . .,..,. . , • , , ?:3. ...,. ::.y..'.::,,,..:,...,:-v.:.,-:..-.--,.."',.;.-,.--.."..-.-,,,ai, ...4r:,e,7L,y..- „- 73,-;-"7".Z.4:=•:.•717',V. :-i'l!::-.".j.',.;'..;•::-..:2;'i,...i."':'4;:-.-:. .... •- . . .-. -- .• .. . . • .:..:F:: ..... . . . . , . . , . . . , . . , . ....4'ir'.;..•.:..' :- . . . , ti. y '..--.. .•.- '',.--=';,.f:1:•..-. .. . , ' . . . , . . . CITY OF CUPERTINO BUILIONG PERIVIIT BUILDING ADDRESS: CO _-:__-,_, NTR.:AM:0R: ' PERMIT NO:B-2017-1148 . : .. 10449 COLBY AVE CUPERTINO,CA 95014-2421(316 29 016) GREEN,PRO SERVICE „ UNION CITY,CA 94587 OWNER'S NAME: SCHINDLER RONALD PANT)ADA H TRUSTEE DATE ISSUED:07/18/2017 OWNER'S PRONE:408-505-8081 PRONE No:(408)372-3026 . . , - , •k.ii t, I t' t -„, :. t, •4. BUILDING PERMIT INFO: License Class C-1Q Lic.#949910 Contractor GREEN.PRO SERVICEDate 07/31/2018 X BLDG . • ••. .-, .• , ., :X ELECT _PLUMB. ? .„,. MECDX RESIDENTIAL__COMMERCIAL I hereby affirm,thatI nut ilionsed wider the provisions of Chapter.9,(comm ..encing , • , with Section"7000).MBivisionl of the Business&Professions Clido 210 that my license is in full force and effect. JOB DESCRIPTION: UPGRADE PANEL(200 AMP)-SAME LOCATION I hereby affirm under penalty of.perjary one of the following two declarations: . , 1. I have and wilt maintain a ee,stificate of consent to self-lie for Worker's. Compensation,as provided for by Section 3700 of the Labor Code,for the . . . purforinance of the work for which this permit is issued. : • ,. ,.,2.,- 'nave and will maintain Worker's Compensation Insurance,as provided for by , ....„ , . ---9 Section 3700 of the Labor Code,for the performance of the work for which tiiis ' .- . . &NV permit is issued. . .. , 'Sq.Ft Floor Area: Valuation:$1200.00 APPLICANT CERTIFICATION . , . . ...., . ,, I certify that I have read this-applIcsition arid 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 autherize, ' 31629016 , ,. . representatives of this cityto enter.upon theabove mentioned property for . • .. . .. . . . inspection purpOses.•(We)agree toaavetndemnify and keep harmless the City of Cupertino against liabilities,140.0!40,costs,and expenses which .- ,PERIVIITEXPIRES if:vyttliticisNOT:STARTED may accrue against said City in consequence of the granting of thispermit. - ' VOITAINt.i.sobAYg Oiciiildittistiiiiikti OR • - Additionally,the appll :":. 4 derstande and will comply with all non point •. -- -,• ,' . !., '-'.. --- .,.-• . -. -- .,, - --•, '. , '--- • , • source regulations .er : - .ertino Municipal Code,Section*18, likiljAYS FROM LAST CALLED INSPECTION. Signature i, Date 7/18/2017 Issued by: BY AYENDE . . Dater 07/18/2017'• . . .. . • . . OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the All: .--shall OOPS • following two reasons; ,- . roofs be inspected prior to any roofing material- being installed.If a roof is ,. 1., I,as owner of the property,or my employees with wages es their sole, installed without first obtaining an inspection,I agree to remove all new materials for • • . inspection. • 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. .- . Signature of Applicant: • contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/18/2017 . . . . . , • . . • I hereby affirm under penalty of perjury one of the following three declaratioes: „ • ALL ROOF COVERINGS-1'0 BECLASSI*Ae OR BETTER 1. I have mid Will Maintain a,Certificate of Consent to self-instim for Worke,r's Compensation,as provided for by Section 3700 of the Labor Code for the. ., .. ,. , , . . . ,•, . ,- . performance of die work for which this permit is issued. . • HAiARDOUS'MATERiALS:OISCLoSiiRE'-. , " • • , 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by ,Ibave read the hazardous materials Ofitilt,*".41*Oti91,94er 695 of the Section 3700 of the Labor Code,for the performance of the work for which this :. California ifenith&liafety.coiletootleee2• 50-5,25534ane 2534.I Will. maintain compliance with the Omen*Affinietinil Code;Uhipter.912 and omit is issued. . - ...„ ... , .. Health&Safety Code,Sudan 25532(ayshould I store Or hinitilehiatirdons. 3. I Genii&that in the performance of the work for which this permit is issued,I Material,Additionally,should I-us'C.eqUiptheirsordiviae6*Meheitit,ltai, ar dMis shall not employ any person in any manner.so as to become subject to the .. idi...eontarnintintais'defiled-hi the Bay.: '3-,"-•`: iktualityManagemeni,Dittrict I Worker's Compensation laws Of California. If,after making this certificate of . will maintain compliance with the Cu.‘., ,.:, vi-,.,i".at Code,Chapter*12 and exemption,I become subject to the-Worker's Compensation provisions of the - the Health&Safety Cede,Sectio.e:I. i,' - 1.,..3,and 25534. . Labot.Code,'must forthwith comply with such provisions or this permit shall t,:, . •,..,- • . . - . . — • be deemed revoked. 3 Owner or authorized agent: (.... .- • -.•- • .. , • ' . APPLICANT CERTIFICATION Date'7/18/2017 - 2',•",• . ' -- - 'i''.-.•-•, •- " I certify that I have teed this application and state that the above information is • • e 8k kil lk I k" '''' correct.I agree to comply with all city and county ordinances and'state lairs '.. I . herebyaffilln that there is a construction lending afleficy•,for the performance relating to building tonetructiort and hereby authorize representatives Of this city"• of Work's for which this permit is issued(Sic.3097,-Civ C.), , • , to enter upon the above mentioned property for inspection purposes:.(We)agree Lender's Name to save indeninify and keep harmless the City of Cupertino against liabilities judgmetits,'.costS,and expensesiehichtneY accrue against seitiCity 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. I understand my plans shall be used as public records. Licensed. • ' Signature Date 7/18/2017 Professional , . . • , ,,,.. . . ,• . 1?) -Z 19-- 1 �?, GENERAL PERMIT APPLICATION Elm E ,. i 'e,"` COMMUNITY DEVELOPMENT DEPARTMENT:•BUILDING DIVISION „� 10300 TORRE AVENUE••CUPERTINO,CA 95014-3255 ' S C- P R I NO (408)777-3228•FAX(408)777-3333•building cupertino.orqCUy . 0PLUMBING ❑MECHANICAL, 1, CCTR1CAL ❑MISCELLANEOUS PROSECT ADDRESS APN# �j (�� _�g } t d / olmd6OWNER NAME � j�e ^' e / PIiOr*g6d0 -.`J� ^•• 5 � E-MAIL STREET ADDRESS CrEY,.STATE FAX !t `_ Cao/b7 Ve i C' ' t..9 , CONTACT NAME PHONE EMAIL STREET ADDRESS CITY,STATE,ZIP FAX �OWNER �y/� 0 CTv NPR-BUILDER 0 OWNER AGENT it: CtSNTRACTOR ❑dONTRACTaR AGENT;,; I- .ARCHITECT. ENGdh'EER E3.-DwIm anit •, 0 TENANT CONTRACTOR NAME LICENSE AR7NTBER LICENSE TYPE BUS LIC# • COMPANY NAMEEMAIL FAX a: r e r t 2,0 i-i�°_'c STREET ADD„ DDy_T STATE,ZIP c !j4 *o PHONE'' ARCEITECTtENGINEER NAME. LICENSE NUMBER BUS.LIC tt COMPANY NAtelE &MAIL FAX ' STREET ADDRESS CITY STATE,ZIP PHONE • USE OF .rt SFD or DUPLEX 0.MULTI-FAMILY PROJECT:N St ILDI AND D YES. PROIECT IN .". E3 YES , : Is'n4E BLbO AN '';" ." 0 YES BUILDING:' :-( OMMEBCt&L' UP.BA I INTERFACEAREA ❑ NOy. FI OOD ZONE 0 NO EICHLER HOME? 0 NO DESCRIPTION OF WORK a . RECEItFED,BY TOTAL VALUATION i ' ttR By my signature beloxv,I certify to each of.the following. 1 am the pro ' •vomer:or authorized agent to act on'the property ovmtr�s beltal I 4a,‘.0 read this application and the information I have provided is corn.4a I ti?. -,.......re,Rescription of Work and•verify ibis accurate I"agree to comply vt th alt applicable local ordinances and state laws relating;to building constructi•n • orize repesentativesofCupertutoto enter the above ide}}ratified ropetty for insppection urposes. Signature of Applicant/Agent. Date: 7, t ,. e _! ` -d SUPPLEMENTAL INFORMATION REQUIRED © i :OVER THE-COUNNTER '. t • t 'D EXPRESS 0 sTarsnAtzn ' a1:1LARGE 0. MAJOR, MEPMiscApp_2011doe revised 06/21/11