B-2017-0776 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0776
11234 CATALINA CT CUPERTINO,CA 95014-4737(356 21 042) JOHN SULLIVAN
CONSTRUCTION INC
CAMPBELL,CA 95009
OWNER'S NAME: PALANKI RAVI AND NAGARKAR ARATI DATE ISSUED:09/18/2017
OWNER'S PHONE:626-818-8730 PHONE NO:(408)247-2147
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#453736
Contractor JOHN SULLIVAN CONSTRUCTION INC Date 07/31/2019 X BLDG X 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:
• 1ST FLOOR ADDITION(110 S.F.);KITCHEN REMODEL(138 S.F.);
I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM REMODEL(143 S.F.);REMODEL DINING/ENTRY/AND
r. I have and will maintaiti a certificate of consent to self-insure for Worker's OFFICE(645 S.F.);REMODEL GARAGE(421 S.F.);(N)FURNACE-
Compensation,as provided for by Section 3700 of the Labor Code,for the ATTIC;UPGRADE ELECTRICAL SERVICE(200 AMP)
erformance 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: 110 Valuation:$60000.00
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 356 21 042 R-3(Custom)
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 r pertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
•
• -. Si.atfr3` re Date 9/18/2017 Issued by:Jasmine Archbold
Date:09/18/2017
OWNE -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 construet;the project(Sec.7044,Business&Professions Code). Date:9/18/2017
I hereby affirm under,penalty'of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. t have andwill'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 ttisued; , maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in;thelperformance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 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 Municipal Code,Chapter 9.12 and
exemption,i become,stibject to the Worker's Compensation provisions of the the Health&Safety Code S tions 25 ,25533,and 25534.
'Labor Code I nus forthwith comply with such provisions or this permit shall
be'deemed revoked.
Own- t? authorized agent: �U
• : 017
APPLICANT CERTIFICATION
I certify that I have read,this application and state that the above information is CONS UCTION LENDING AGENCY
correct.I iagree 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 constructien,iand,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 ands 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'ell nori-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 9/18/2017 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO:B-2017-0776
11234 CATALINA CT CUPERTINO,CA 95014-4737(356 21 042) JOHN SULLIVAN
CONSTRUCTION INC
CAMPBELL,CA 95009
OWNER'S NAME. PALANKI RAVI AND NAGARKAR ARATI DATE ISSUED•09/18/2017
OWNER'S PHONE.619-241-6884 PHONE NO:(408)247-2147
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class a Lic.#453736
Contractor JOHN SULLIVAN CONSTRUCTION INC Date 07/31/2019 X BLDG X ELECT _PLUMB
X MECH X RESIDENTIAL_COMMERCIAL
I hereby aftirm 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
1ST FLOOR ADDITION(110 S.F);KITCHEN REMODEL(138 S.F);
I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM REMODEL(143 S.F),REMODEL DINING/ENTRY/AND
1. I have and will maintain a certificate of consent to self-insure for Worker's OFFICE(645 S.F)•REMODEL GARAGE(421 S.F);(N)FURNACE-
Compensation,as provided for by Section 3700 of the Labor Code,for the ATTIC;UPGRADE ELECTRICAL SERVICE(200 AMP)
/}pe ormance of the work for which this permit is issued. REV#1-ADD(N)WINDOW-ISSUED 11/9/2017
I have and will maintain Worker's Compensation Insurance,as provided for by REV#2-ADDITION(19 S.F);(N)EGRESS WINDOW(1)-SAME
`-/ Section 3700 of the Labor Code,for the performance of the work for which this LOCATION-ISSUED 12/14/2017
permit is issued.
Sq.Ft Floor Area.110 Valuation.$60000.00
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 356 21 042 R 3(Custom)
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.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION
Signature - Date 12/14/2017 Issued by-Jasmine Archbold
(' Date:09/18/2017
OWN 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: 12/14/2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
a. 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 I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,1 must forthwith comply with such provisions or this permit shall the Health&Safety Code, ; cion 515,25533,and 25534.
be deemed revoked. J
Owner,or authorized agent: -
APPLICANT CERTIFICATION Date:
I certify that I have read this application and state that the above information is -- CONSTR 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 12/14/2017 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0776
11234 CATALINA CT CUPERTINO,CA 95014-4737(356 21 042) JOHN SULLIVAN
• CONSTRUCTION INC
CAMPBELL,CA 95009
OWNER'S NAME: PALANKI RAVI AND NAGARKAR ARATI DATE ISSUED:09/18/2017
OWNER'S PHONE:626-818-8730 PHONE NO:(408)247-2147
LICENSED CONTRACTOR'S.DECLARATION BUILDING PERMIT INFO:
License Class a Lie.#453736 •
Contractor JOHN SULLIVAN CONSTRUCTION INC Date 07/31/2019 X BLDG X 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:
1ST FLOOR ADDITION(110 S.F.);KITCHEN REMODEL(138 S.F.);
I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM REMODEL(143 S.F.);REMODEL DINING/ENTRY/AND
1. I have and will maintain a certificate of consent to self-insure for Worker's OFFICE(645 S.F.);REMODEL GARAGE(421 S.F.);(N)FURNACE-
Compensation,as provided for by Section 3700 of the Labor Code,for the ATTIC;UPGRADE ELECTRICAL SERVICE(200 AMP)
,.t erformance of the work for which this permit is issued. REV#1 -ADD(N)WINDOW-ISSUED 11/9/2017
I.'7'. 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: 110 Valuation:$60000.00 ,
•
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 356'21 042 R-3(Custom)
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.he Cupertino
U V �Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
,•�• V�V/ivnnn/// '
(, `ature Date 11/9/2017 Issued by:Jasmine Archbold
Date:09/18/2017
OWNER-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:11/9/2017.
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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 l 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 Municipal Code,Chapter 9.12 and
exemption;I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Fail'ner or authorized agent: •
APPLICANT CERTIFICATION Date: 11/9/2017
I certify that I have read this application and state that the above information is CONSTRUC ION 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.
Licensed •
Signature Date 11/9/2017 Professional