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B-2017-1562 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1562 10121 CRAFT DR CUPERTINO,CA 95014-3474(375 02 009) DALCON SAN JOSE,CA 95110 OWNER'S NAME: YEE HELEN J AND ANDREW E TRUSTEE DATE ISSUED:09/13/2017 : OWNER'S PHONE:650-245-4102 PHONE NO:(408)278-1809 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#582916 • Contractor DALCON Date 12/31/2017 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: REPLACE(1)MAIN PANEL-(RELOCATE 5'FROM THE FENCE); I hereby affirm under penalty of perjury one of the following two declarations: REPLACE(2)SUBPANELS(100AAMPS)-SAME LOCATIONS; i. 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. p I have and will maintain Worker's Compensation Insurance,as provided for by i. permit Section 3700 of the.Labor Code,for the performance of the work for which this ' permit is issued. Sq.Ft Floor Area: Valuation:$12000.00 ,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 375 02 009 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save irdemnify and keep harmless the City of Cupertino-•ainst liabilities,judgme:ts,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue again said City in, segue e of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the a•slicant und- t nds a will i •• with all non-point source regulation per the CU it ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. LA. Signature I Date • 3 05 Issued by:Jasmine Archbold ( Date:09/13/2017 • e J ER-B ,LD ' s_C `t:__t I.� I hereby affi ..t�at am Jaempt from the Co tr clot's License Law for one of the RE-ROOFS: following two e'son•: / All roofs shall be inspected prior to any roofuig material being installed.If a roof is 1. I,as. er of a property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensat in will do the work,and the structure is not intended or offered for inspection. sale(Sec.7 ,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:9/13/2017 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 255 •. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter'.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 o !andi azardous I } material. Additionally,should I use equi!1.ent or devi •s w.Ich : . t hazardous Shall not employ any person in any manner so as to become subject to the / air contaminants as defined by the Bay• •a Air Quail t :nag•,.ent District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuper�t no Municip.•/Co:e, t:a'ter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the • the Health&Safety Code,.ec it ns 25505, 534 Labor Code,I must forthwith complywith such provisions or this permit shall / '' 4 be deemed revoked. Owner or authorized agent: .._I/ APPLICANT CERTIFICATION Date:9/13/2017wmurai I certify that I have read this application and state that the above information is '` t "" lf'" correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co struc i•n len ing agency fort e perf'ormance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is ssu d Sec. 097,Civ C.) ii 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 9/13/2017 Licensed Si g Professional CONSTRUCTION PERMIT APPLICATION ,�,�� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 e.I9s` (408)777-3228 • building@cupertino.org PEMIT#B- - CUPERTINO REV# DEF# Q NEW CONSTRUCTION ID ADDITION 0 ALTERATION 0 T.I. l P ❑RE-ROOF El SWIMMING POOL/SPA PROJECT ADDRESS APP,# lbQ--1CZ-Cr 'Y- OWNER NAME PHONESU �� E-MAIL Chr, �e *P. -HoZ STREET ADDRESS CITY, STATE,ZIP ❑CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE I Tal cor ri cc �S?�r 1 C)b I STREET ADDRESS (��/� { _,(A-M. CITY,STATE,ZIP /�� G� �7�j-? `V � U1 UI - SGtVI ,)CJ�d2 C 1 ( ��' O E-MAIL PHONE BUS.LIC# Service rciLCc leleGj-r,'o.cu�� t�0 27� ? O— 1423(l (P 0 ARCHITECT ❑OWNER ❑OWNER AGENT,aCONTRACTOR AGENT 0 ENGINEER❑DEVELOPER❑TENANT CONTACT NAME„..-,CaY k)s �l-avertruitet�clC,�Loin 2(,ec4-ric_ Co v, STREET ADDRESS CITY,STATE,ZIPPHONE -7-C7 Q C s-VykU 1- i-4-- 'DG h J ns-e CA 't it. 0 '4O8 78] 'f/ ( 2, DECRIPTON . �-�\C3t C-2 7-420 �vv, �Yh E J cY 14-16M ��Vr�2 t -For l I-�e -44 C ke 1 0' mei -c c cke U �J - 1 © 1 Do o�vnp pub rQ.�s -fes (Pee ore c (ok_c �..p k Vie.. - (1 b_e..e ❑SINGLE-FAMILY/DUPLEXp�.MULTI-FAMILY ElINDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NE FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET Si” USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED EXISING 13 YES EICHLER ❑YES SECOND STORY ADDITION O ES FIRE SPRINKLERS 0 NO 0 NO DWELLING SECOND DWELLING ❑Y ❑ATTACHED❑DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F POOLS' ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED DYES ❑NO I TOTAL-SF T IVED BY: TAL VALUATION: Commercial or Multi-Family Buildings with Public Swhnminp Pools requires Department ofEnvironmental Heath approval � 2 1 1 RE-ROOF I EXISTING ROOF TYPE 0 BUILT-UP ROOF 0 ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIE ) REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1„ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS DYES I #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑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: am th property owner or authorized agent to act on the property owner's behalf. I have read this application and the info, ation I have o tided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local oro antes and /te laws r lating to .uilding construction. I authorize representatives of Cupertino to enter the above-identified property for; spection o.e . ckno edge and authorize all information co tained on this application form to be made available for public record.1 .. Signature of Applicant/Agent: Date: ' q &J (7 SUPPLEMENTAL INFORMATIO I REO Il *New SFD/Second Dwelling Units t ultif.. ' P ellings:A Demolitio r rmit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a compl:te. .zardous Materials Dis' . ure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter o --tin: ith Planning prior to su.mittal of Building Permit application. *HOA-Provide a letter of approval from the H. e Owner's Association BldgApp_2017.doc revised 08/01/17