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B-2016-1244CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1244 10661 CARVER DR CUPERTINO, CA 95014-3606 (375 34 050) OWNER/BUILDER OWNER'S NAME: RICCARDO FORLEO & DOROTHY LIN DATE ISSUED: 03/03/2016 OWNER'S PHONE: 408-828-8426 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER/BUILDER Date X BLDG —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: REVISE TRUSS SYSTEM (DIFFERENT TRUSS COMPANY) AND I hereby affirm under penalty of perjury one of the following two declarations: SHOW RAFTER DETAILS. REDUCE SIZE OF 1 SLIDING GLASS 1. I have and will maintain a certificate of consent to self -insure for Worker's DOOR AND 2 WINDOWS. Compensation, as provided for by Section 3700 of the Labor Code, for the PARENT PERMIT 13080187 performance of the work for which this permit is issued. 2. 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 Sq. Ft Floor Area: Valuation: $0.00 this permit is issued. 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 375 34 050 authorize 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST NSPECTION. Code, Section 9.18. Issued by: EL SA N Signature Date Date:ji .3416 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 9 owing two reasons: installed without fust obtaining an inspection, I agree to remove all new materials for 1�r 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Q� t. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 33, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Mur Ja o e, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(x) should ffto a or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use pment or dev es which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the ay Area Air u ty Management District I will maintain compliance with the u rtino M nic al Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Co e, ctions 2 0 25533, and 25 exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall Owner or uthor ed agent: .001 be deemed revoked. Date: O ®� I R I EN T CERTIFICATION I certify that I have read this appli at on and state that the above information is I hereby affirm t at there is a c nstruction lending agency for the pertormance correct. I agree to comply with a ci and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction a hereby authorize representatives of this city Lender's Name to enter upon the above menti ne property for inspection purposes. (We) agree to save indemnify and keep h r ess the City of Cupertino against liabilities, Lender's Address judgments, cos s, and expe a which may accrue against said City in consequenc of he grantin of his permit. Additionally, the applicant ARCHITECT'S DECLARATION understan an will comp) th all non -point source regulations per the I understand my plans shall be used as public records. Cupertino uni !pal Co S ction 9.18. Licensed Signatur Date - O Professional CONSTRUCTION PERMIT APPLICATION CONT UNI if D=VELOP1ucNT D_PARTKIZN-. BUIDING DIVISION r -� 10300 TORRE AVENUE • CUPER T 1NO, CA 55014-3255 40B 777-322B - FAX 408 777-3$33 - buildin° cu tin .Or� CUPERTINOO �' D ° ° _ 1rW CONS RUC7014 AIT'=RATiON/TI i 'vi5i ORiGTINA Rj,,7- A0 -- C°iV-,ACT 1\�1✓•� F�DicSS ❑ OW7uR' N'1v�i -SLeZD . STA l L, Li w ,- 'r .. I ...n Elov,'.� AgES-r ❑ co>,�CTOR ❑ Co1.0 4CTOR AM,7 ❑fU.C=_CT ❑plc — ❑ D� =Lo? ❑ =1 f �-r COh1-tIACTORTA3�= - ,! �Il I �C SE?dUh�i-r-it I L1C?:5_TY'r£ I �'-f- BUS. uc# col,eA.YTfa� I NtiZ FAX S?7._.tT ADDR ss C1 S', S i A i c, ZI? on L n. Hz.- represen_cives'of C'_pertiDo to c 1- ne above -id -led proper] for inspection pL-poses. f3.C7T i�*OD: R'/J✓: I LICL��_.\J1J�R I BUS. 1iC9 T �y OCC. SQ.PT. V.= S:�i=Er ADDR'-_ss I C-11 Y, s 1 Ais Za I ?SOT �_— Fa_r_1.G us_ ?Ro. os_D us=_I CONSTR T Yz_ T ?_s owmcT's oohs _.Ihave;:Fd thls application and the infot:�.zti-' I hw prove - - I on L n. Hz.- represen_cives'of C'_pertiDo to c 1- ne above -id -led proper] for inspection pL-poses. I `_ L-� T �y OCC. SQ.PT. V.= ^ B)CSTG ?,V FLOOR D=1110TOTfS, J �Di GST �t . irk prier :SSL'_ Oi DLLIdi:�- - �e.m;t for new bu ldina, i�ar-,y ^r c `�� _ lu._., fRA . I ,Z�tR.A t 'c-1'. =.y I' -cols Mz.erizis _. e; -g'__, -d as part Of *,,:s ?reject. y` ?Air]t00 d KI?Ct£=N OTr_R 'o-� t i SL'bmitial Of ELild_•1 t application. R fODEL! A REMODEL A.ILA ?=,i0DEL : ==.6, ?OR CH/JeA D_CKAREA W-AC=f_RaAA DETACIR - I ❑ AT TA I :DWSLUN*U'TTrS: ISASECOND UNrr ❑Y=S SECOPDSTORY ❑�:S BUNG ADDED? NO ON? r- ??Z :I e?LIGATION ❑ 1.5 7 1.5, PRO -NIM COPY OF IS Tii BLDG E K \ ,S Cit ='� -OT.-J. V� I I.O?�: ?LF? NTNG .P?L 9 ] NO ?L/? NMN'G f ROYAL L:ITR ETCH cR HOME? a My -,.y slmanre D:iow,1 cera• o ee� or ne ia!o,; ^ ' 1 zn he 70 i_r Or aX..hori2eC P t0 2ct 0 C I P pa: r" owmcT's oohs _.Ihave;:Fd thls application and the infot:�.zti-' I hw prove ed s cer; t, I h ; ead the Desc; iplio1 of Zr,�o:k end verij' nate. I FF:e to -c •with all ppliczbie 1ocz1 o; dinznces and stave laws relating to Liidin on L n. Hz.- represen_cives'of C'_pertiDo to c 1- ne above -id -led proper] for inspection pL-poses. S7natLreof Applim-It/A_ent: Date: ©/` 27 (_ 9 SUPT FMNTA 0!ZM.A _ 5rt — Nnv SFD or ? /_' '.i:=�- L'•' C� -: eliinc5: v } .`Oi CD OIiaOZ �el—it EKiSil'�g bL1lC':r?g(5). re-OlalOi7 •^ywT..Jt 1S :eOLirea t0 -?Ce Dpi = CGL'�T J �Di GST �t . irk prier :SSL'_ Oi DLLIdi:�- - �e.m;t for new bu ldina, i�ar-,y ^r c `�� _ �,� ��� �i'\"�. h �� ••,�.' Co'-eIC:a1 Bldgs: Provide a co-pleted-=?ardOUs Materials D?SCICSLre 1�Dd t 'c-1'. =.y I' -cols Mz.erizis _. e; -g'__, -d as part Of *,,:s ?reject. y` " Copy of.PlaIng Approval Leer or l ee ire ;;;ill PI=-ninQ _Drier to ,PC_-=., 'o-� t i SL'bmitial Of ELild_•1 t application. B&g ,�RP_2011. doc revised 06121/11