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B-2017-1723 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1723 998 SEPTEMBER DR CUPERTINO,CA 95014-4141(362 15 024) ALL BAY SOLAR CONSTRUCTION INC SAN FRANCISCO,'CA 94112 OWNER'S NAME: KUMAR ASHOK AND NEELAM TRUSTEE DATE'ISSUED: 10/06/2017 OWNER'S PHONE:408-772-5780 PHONE NO:(415)624-3535 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: . License Class C-10 Lic.#962034 • Contractor ALL BAY SOLAR CONSTRUCTION INC Date 09/30/2019 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: PANEL UPGRADE-(125 AMP) I hereby affirm under penalty of perjury one of the following two declarations: 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. tI 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:$1000.00 ' 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 362 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 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. • Signatt .---- Date 10-6-2017 Issued by:Kim Dunbar Date: 10/06/2017 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 coistruct the project(Sec.7044,Business&Professions Code). Date: 10-6-2017 thereby affirm under penaltyof 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 performanceof'the work for'which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. 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 to 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 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,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,jI must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agen (.` G • APPLICANT CERTIFICATION Date:10-6-2017 1 ( I certify that I have read this application and state that the above information is CONSTRUCN LENDING AGENCY correct.I agree to comply withall;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-pointisource regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I 1 I understand'my plans shall be used as public records. Signature ' Date 10-6-2017 Licensed - Professional • 1 / CONSTRUCTION PERMIT APPLICATION 1 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION rtki, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building@cupertino.org PEMIT#B-10/ - I nZ 3 CUPERTINO REV# DEF 14 ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. LJ MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS ci ct 8 Se's n,,, 9-et1 Dr C✓p -V?0 o APN; 3 2 - l/.c --h 2 OWNER NAME A Jv`v � � PHONE 42,8_3,425,ceMAIL STREET ADDRESS J CITY, STATE,ZIPT �l�8 Se p4ew1o Cdpesl- n.v v °No 1 f [CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME I LICENSE NUMBER LICENSE TYPE to 5 AV e- 'e-- ' Mt 6A,�/ 5Dlo-1 1 733 q- C 10 C 4 6 ' STREET ADDRESS i l CITY,STATE, ZIP S& 1 141 t551an s(9-. ''� �rancrS�� C/ 1/4//Z E-MAIL PHONE BUS.L C rrl,��� �I��arsp�df�Car� 4-IS- G24 ; g a30•7i . 74/1 ❑ARCHITECT 0 OWNER ❑OWNER AGENT 41-CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E-MAIL C (10)04 11)0141 (� n..()Q0,11 loay50/ . Caw- STREET ADDRESS CITY,STATE,ZIP PHONE S 8 cog g47-55,0 n 5? St1, 1 F(„46)-(.. cp. 4/5-624- 3S 7 S •6l DECRIPTON //�ec.--icr(V-r .S4Iw°C( V f fo-.c1 Y ( frost.- )00 'f° )2.S A ©SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF ' DECK SF DEMO SF STORIES I TOTAL NET SF USE . TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR I GARAGE ❑ATTACHED BATHROOM SF SF SF I SF 0 DETACHED • EX1STNG ❑YES .EICHLER ❑YES SECOND STORY ADDITION DYES FIRE SPRINKLERS 0 NO ❑ NO 0 NO DWELLING SECOND DWELLING ❑YES D ATTACHED 0 DETACHED OTHER UNITSI UNIT ADDITON: 0 NO S F _ POOLS! 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF • R4'') f�/ ///� TOTAL VALUATION: Connercia!or Multi-Family Buildings with Public Swimming Pools requires Department or Environmental Heath approval /i�� __S/jJy�/� _ l' Ov RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS DYES POFLAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER '12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF lot 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 applica[ion 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 ins section purposes. I acknowledge and authorize all information contained on this application form to be made available far public record. ,Signature of ApplicanAgent: Date: (OA C/(j - 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 Apprioval 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/I7