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B-2017-1745 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1745 22292 REGNART RD CUPERTINO,CA 95014-4845(366 47 015) VIA BUILDERS INC LOS ALTOS,CA 94022 OWNER'S NAME: YATES MICHAEL J AND KATHRYN M TRUSTEE DATE ISSUED: 10/11/2017 OWNER'S PHONE:408-253-5311 PHONE NO:(650)948-1077 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ja Lic.#717805 Contractor VIA BUILDERS INC Date 01/31/2018 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: INSTALL(N)AUTOMATIC GATE INTO DRIVEWAY 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. 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:$40000.00 Ia` 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 366 47 015 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 regulati. s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatu V • Date 10-11-2017 Issued by:Kim Dunbar Date: 10/11/2017 O 'ER-B DER 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. 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(S417044,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: 10-11'-2017 I hereby affirmurider 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 y ' i'I ... • ,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 haveiand 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 pO' '':Imaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the nut ISI issued. Health&Safety Code,Section 25532(a)should I store 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 equipment or devices which emit hazardous sl all'not employ any person'in any manner so as to become subject to the 1 ,. air contaminants as defined by the Bay Area Air Quality Management District I Workers Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemphon,I'peconie subject to the Worker's Compensation provisions of the the Health&Safety Code,S ctions 25505,25533, 25534. Labor Code,I must forthwith comply with such provisions or this permit shall • • bedeemed revoked. Owner or authorized agen APPLICANT CERTIFICATION Date: 10-11-2017 I certify that I have read this application and state that the above information is CON UC4'ON 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.expense's 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 10-11-2017 Professional / CONSTRUCTION PERMIT APPLICATION .\/r' 1/CCOMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ( 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 l /�,7J� 41.,,p,s ( (408) 777-3228 • building@cupertino.org PEMIT#B- _n/1 I CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION Ni. ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS \ APN# r �c W c 366- 4/-0tS OWNER N 9� PHONE E-MAIL n' rkI A`eC�ept!( 4. K 'OS-a�3-�3t‘ , �Vty��ES� Y�UrR�Q_w�e� wwtn dc���-` ' STREET ADDRESS q` CITY, STATE,ZIP t ` o ®CONTRACTORNAME 0 OWNER BUILDER COMPANY•NAME Cv�C I vLICENSE NUMBER :\ LICENSE TYPE ISTREET ADDRESS �&i/ CX V�— V l 0\ jCJ ik l7 L riS HC TTY,.STATE, 105C 6ao Ft Cawi;iu ' -gem his //f s C4 gt(o PL-a_ ' I E-MAIL ``� `d\ PHONE ( BUS.LIC F iJ LOLE141(\ 42 t--- 21 MAA-c1- co=vim VV 2_'c ` 1 ❑ARCHITECT ❑OWNER WNER AGENT Igg CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER❑TENANT CONTACTAME E-MAIL JOS el Fa-4s vrex btttfd•‘)r_s e \IWO;/- cam STREET ADDRESS WOO CI4 CGI4146 R.12- ✓� CITY,STATE,ZIP PHONE el)9- _ s 4/COs C ' 9io a Q 6S0-g t-/ 7 .7 DECRIPTON j '' /� p ( ZL'` r r1 la O ..c.1 —r D `61e,..12.l Ewa e _ kp d .„„4_E-.5 cl si._4 i 011)..5 y,, t2,( (.J Ado 6(.04 `t(E q„Cis 't, O r e%/eweC igSINGLE-FAMILY/DLJPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF] PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC ' SQ.FT. VALUATION($) S 7)- Z5 0 �, REMODEL ,IREMODEL KITCHEN REMODEL GARAGE -ATTACHED .. BATHROOM,SF ff., !!SF SF SF F./ ❑DETACHED •EXISINGNOS i IEICHLER ❑YES SECOND STORY ADDITION YES r FIRE SPRINKLERS I ©•NO, L+J DWELLING SECOND DWELLING ❑YES i0 ATTACHED❑DETACHED OTHER UNITS# 1 UNIT ADDITON:' �NO,';' SF ' '❑FIBERGLASS' 0 VINYL-LINED,,❑GUNITE 0 PREFABRICATED POOL-SF 1 c SPA,SF. I SPA'AITACHED❑YES 0 NO TOTAL-SF I I RECE /l jile/L,ITOTAL VALUATION: Com mercial or Multi-Fauulu Buildings with Puttee Swimming Pools requires Department of Environmental Heath approval / /,�/lf I I..' d,/ (( VVI 21 C P':EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE 0 NO,, IF NO i ' PLYWOOD ❑1/" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS Eiyg #OF LAYERS+ I THICKNESS❑5/8" OTHER ❑OSB ElCDX OTHER .12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOFh DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *provide a signed co�py�of the Cupertino s Tear-Off Policy SF #of 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 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 propertylfor ins ction purposes. a owledge and authorize all information contained on this application form to be made available for:public record. p Signature of Applicant/Agent: Date: ( p-2- /7 SUPPLEMENTAL INFORMATION REQUI D • • *New SFD/Second Dwelling Units/Mult family 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. i *HOA-Provide a letter:of approval from the Home Owner's Association li . p t( flhI4 & ovvBB1dgApp_20'17.docrevised08/01/17` '