B-2017-1712 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1712
10863 LEAVESLEY PL CUPERTINO,CA 95014-4788(356 15 024) SST CONSTRUCTION
LLC
RANCHO CO,RDOVA,
CA 95742
OWNER'S NAME: WILSON ERIC K AND SUSAN C DATE ISSUED: 10/04/2017
OWNER'S PHONE:408-481-8995 PHONE NO:(916)879-5984
•
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_10 Lic.#1009107
Contractor SST CONSTRUCTION LLC Date 11/30/2017 X BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
MECH X RESIDENTIAL_'COMMERCIAL
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);(N)SUB-PANEL(100 AMP);(N)SUB-
I hereby affirm under-penalty of perjury one of the,following two declarations: PANEL(200 AMP);
1. I have and will maintain a certificate of consent to self-insure for Worker's INSTALL NONEXPORT BATTERY SYSTEM(13.5 KWH)
Compensation,as provided for by Section 3700 of the Labor Code,for the
Adperformance 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:$20000.00
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 15 024
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 Cupertinoagainst 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.
Sig ay f�r,." AMC' Date 10/4/2017 Issued by:Abby Ayende
Date: 10/04/2017
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: 10/4/2017
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'persop 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 •K
be deemed revoked. Owner °zittjt ized agent:
APPLICANT CERTIFICATION Dat• , 1rif_f
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply'with all cityand 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 10/4/2017 LicenseProfessionald
CONSTRUCTION PERMIT APPLICATION
\ / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
^v 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
,,,ST.ISJJ (408)777-3228 • building@cupertino.org PEMIT#B-2.o I°3- - \-1 I Z
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION 0 T.I. ❑MEP 0 RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRES7 /J L6. �/ a I APN# 35-6, o^J-(
OWNER NAME / `/") L/ �PH E-MAIL `� (l sJ
iel
5
STREET ADp�RE � i�,„ /�fj / / /fS �Lr!/l�® KU/�
Vi•NIR[/A[/CTOR NAME ❑OWNER-BUILDER c CCO'l ANY NAME ( LICENSE NUMBER LICENSE TYPE
o%/0/'IAi 412‘11)J r/---- ' 9r0CrAirdlidiii 7Cd Clc-- P1o`7 ✓-4/-6- Ckt'
isi giriza go Fir-e-i9 =az), elootivit,e44_, s.....to_j___
E 0 r. 4-t---16 6 . PHONE zsz—`497 IBUs
0 ARCHITECT OWNER
ES OOWNER 0 OWNER AGENT ON1RACrORAGENT❑ENGINEER 0 DEVELOPER 0 TENANT
CONTACTE-MAIL
/7'vf bprige �
a0-y
STREET ADDBWto (iv CITY,STATE,ZIPVI PHONE
7/7
�r 2'jt°D
DECRIPTON4 et: ,,1,,� ) / 13,�'""r ( / y r�� ��Z'm I
iII NA) 6612-0 ',0 Cep e7 7G 22's GA
ri ' -11 .' 06 pi eCS 2 a mmniv / 1 2- --t L -t0t ,
SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SFI PORCH SF DECK SF DEMO SF STORIES B TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OIHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EASING ❑YES EIcij.ER ❑YES SECOND STORY ADDTnON 0 YES
FIRE SPRINKLERS LERS❑NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑Y S 0 ATTACHED❑DETACHED OTHER
uNFrs: UNIT ADDITON: 0 NO S F
POOLS ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED❑YES 0 NO I TOTAL-SF4
ID CEIVBY: I \ TOTAL VALUATION:
CommercialCommcial or Multi-Family Buildings with Public Swimming Pools requires Department of Enairoxracnie!Heath aeproaal
At4
A�^ t�^y[J41724 /
RE- OOFI EXISTING ROOF TYPE ❑BUILT-UP ROOF❑ASPHALT SHINGLES 0 WOOD SHAKES El SHINGLES 0 TILE OTHER(SPECIFY) (/i�"JO�S
R
REMOVE/REPLACED NO IF NO _
, ' PLYWOOD El 1/2" 03/8" PLYWOOD TYPE PITCH: ROOF CLASS
OyEs #OF LAYERS THICKNESS❑5/8" OTHER El OSB ❑CDx OTHER :12 A
PROPOSED ROOF TYPE❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy(Otte Cupertino's Tear-Off Policy SF rof SQUARES
By my signature below I'ceitify 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 property for insp .' purpos- I acknowledge and authorize all information contained on this application form
to be made available for public record. •
Signature of Applicant/Agent:: �/ Date: II I
SUPPLEMENTAL INFORMATION REQUIRED ,
'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
B1dgApp 2017.doc revised 08/01/17