B-2017-1559 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1559
22930 CRICKET HILL RD CUPERTINO,CA 95014-2637(342 35 008) BIGHAM SERVICES
INC
SANTA ROSA,CA
95404 -'
OWNER'S NAME: GOEAS BRUCE M AND CHRISTINA M DATE ISSUED:09/12/2017
OWNER'S PHONE:408-267-1789 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#740999
Contractor BIGHAM SERVICES INC Date 10/31/2017 X BLDG _ELECT _PLUMB
X 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:
REPLACE FURNACE SAME LOCATION;REPLACE AC UNIT SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION
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:$10000.00
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 342 35 008
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.
Signatur-� 6 Date 09-12-2017 Issued by:Kim Dunbar
r, Date:09/12/2017
OWi�_R-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
1. 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 of Applicant:
'contractors to construct the project(Sec.7044,Business&Professions Code). Date:09-12-2017
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. 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 fuse equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management.District 1
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 ections 25505,25533,and 25534.
Labor Code,I inust forthwith comply with such provisions or this permit shall V.be deemed revoked. Owner or authorized agent: BVI
APPLICANT.CERTIFICATION Date:09-12-2017
I certify that I have read this application and state that the abpve information is CONST CTION 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. I understand my plans shall be used as public records.
Signature Date 09-12-2017 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
// COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
v • 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
4, 'sem (408)777-3228 • building@cupertino.org PEMIT#B- O$ r- - I 5.-5-e
CUPERTINO REV# DEF#
0 NEW CONSTRUCTION ❑ADDTITON 0 ALTERATION 0 T.I. el MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS7^^L C1 IC) Crl ck 1��11 a APN# 3 Lil ^E- — 3 L/
- M 0 g
OWNER NAME PHONE E-MAIL
)rVO e G OeO6 (14o$)2-67'RN
STREET ,./ /
7^ TE,ZIP
iO ,O Cir.ick� ►1-111 _ \, Cu-
W uTY, r4iry Co-, ci6O \
CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
C'V - Tc " c 7��q9`I G-2...0I STREET ADDRESS „, CITY,STATE, ZIP I
11-100 Mtit - 14111 RA, S Roses Co, 95C-10/i
E-MAIL PHONE BUS.LIC#
(7o )6115 -1 Soo
El ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME { 1 E -MAIL
&,J
ITY,STATE,ZIP
STREET ADDRESS Moo PCJI V'1 urvo- \c\\ a. Csj- RQ.,__. Ca”, q5(()� PHONE
(70 )546- 00
DECRIPTON ReP)o- Af moo- SEER ILI Al-,u go
ppSINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 9 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISING OYES EICHLER ❑YES SECOND STORY ADDITION OYES
FIRE SPRINKLERS❑NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: ONO S F
POOLS' ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED 0 YES ❑NO I TOTAL-SF
'REC 4'/ TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental.Heath approval Ca/000
RE-ROOF'EXISTING ROOF TYPE: 0BUILT-UP ROOF 0 ASPHALT SHINGLES❑WOOD SHAKES 0 WOOD SHINGLES 0 TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF,NO PLYWOOD 01"" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
DYES #OF LAYERS THICKNESS 0 5/8" OTHER ❑OSB 0 CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 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 proper for inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public rec rd. of ^�
Signature of Applicant/Agent: O�nn91. l VIA 1/ I 1
SUPPLEMENTAL INFORMATION EQUIRED
*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 08/01/17
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August 25,2017
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I Paul Bigham(owner),hereby give my authorization to Archon Energy Solutions,and its
Agents;_Nicholas Medlin;Lucas Kiioepfle, Lac;Elfers,James Dowton,Randy•Fox,Joshua
Young,,and Casey McCabe,on my behalf to request,pick up and/or payKany applicable fees for
.1 mi ,�. Sr`3 Y`,TAA g i i {
buildingFpermts and business licenses on behalf of our company,Brigham Services DBA One 4.-.,.,,,,,:,,;,,,,,,k
Hour Hearing&A�r;Conditioning;and Mister Sparky Electric. I ensure my'full consent for this y} ..
authorization
If you should have any questions,,please•contact me for my staff at 707 5'45 5900,
•
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V
.
•
Thank�You,
.•Paul Bigham .
tama Hill R
1400 Pelud
Santa Rosa,`'-CA 95404
Phone`(707).545-5900
Fax (707.):53A 80
•
License`#'740999"
y Serving The Entire Bay Area! •
•
Phone:(877),894-2577 'F'ax;(707)...,,,,,F,,, , 1,.,,...7:93
www.onehourheat,andac.com / License#740999
• Corporate Office: 1400 Petaluma Hill Road/Santa Rosa, CA 95404