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B-2017-1753
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1753 20563 STEVENS CREEK BLVD CUPERTINO,CA 95014-2106(326 34 044) GOODMAN ELECTRICAL INC ACTON,CA 93510 OWNER'S NAME: SAICH JOHN M TRUSTEE&ET AL DATE ISSUED:10/12/2017 OWNER'S PHONE:408-725-4228 PHONE NO:(661)526-5337 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lie.#886488 Contractor GOODMAN ELECTRICAL INC Date 04/30/2019 X BLDG X ELECT _PLUMB MECH_RESIDENTIAL X COMMERCIAL 1 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 EXISTING FLOOD LIGHTS (8) 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 1 I °' 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:$18434.35 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 326 34 044 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 abilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said/ ity in c:nsequerice of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,t applic. t under: and will comply with all non-point source regal. •.ns per'I e Cup/ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signet.1'0' A Date 10-12-2017 Issued by:Kim Dunbar '' Date: 10/12/2017 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 roo ing 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,-i inspec'-Fn,I agre, o remove all new materials for compensation,will do the work,and the structure is not intended or offered for in:, ction/ sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applica " .- :fig contractors to construct the project(Sec.7044,Business&Professions Code). Date:10-12-2017 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 r 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 die 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;I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed'revoked. Owner or authorized agent: ' APPLICANT CERTIFICATION. Date: 10-12-2017 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 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 10-12-2017 Professional CONSTRUCTION PERMIT APPLICATION p /� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION : B t' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • wg4•T),sr - (408) 777-3228 • building@cupertino.org PEMIi 0- I -� __ CUPERTINO REV DEF# ❑ NEW CONSTRUCTION ❑ADDITION A ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS _ to 3 Gra/ ��i„ 13Lvb, APN✓1 OWNER NAME AO`v/4 L� /)_ N/a_I+n p vo nE vs- 9'228' E-MAIL STREET ADDRESS 0 //"•tY��Ltlw//� (��/ 77�jf CITY, STATE,ZIP V tl CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE IIS . rogBg' e- 10 I STREET ADDRESS C W 6kei& it t. CITY,STpC/,V ZIP AI Co .1`3 r ° I E-MAIL by;0 /I`112. 603r`ttilY •co y\ PH(/ C 6, 6 3 3 7 , BUS. LICC I 0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER'0 TENANT CONTACT NAME E-MAIL • STREET ADDRESS CITY,STATE,ZIP PHONE DECRIPTONehti ' ‘e DA0 ii2- ©/1 se �/T/v / /7!/ S' aotr i9pviirs 474 s tv Ga - ❑SINGLE-FAMILY/DUPLEX . ❑MULTI-FAMILY 0 INDUSTRIALCOMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODELOTHR I GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED EXISTNG DYES EICHLER 0 YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS 0 NO 0 NO 0 NO DWELLING SECOND DWELLING ❑yES ❑ATTACHED❑.DETACHED OTHER UNITS# UNIT ADM-TON: ❑NO S F POOLS' ❑FIBERGLASS, D VINYL-LINED 0 GUNITE ❑PREFABRICATED POOL-,SF SPA-SF, I SPA ATTACHED ❑YES 0 NO I TOTAL-SF R hi feTA Conuuerciul orMulti-Family Buililiugs with Puhlic:Swinuuing Pools reatfires Deroartmes!v(Envirmtmenful Healh avurvvnl E 1, T `i O RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF['ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE%REPL'ACE❑NO IF NO PLYWOOD ❑'h" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS I . DYES #OF LAYERS THICKNESS❑Sir 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 Policyi SF #of SQUARES By my signature'below I certify to each of the folio,ing: 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 e prov,ied is correct. I have read the Description of Work and verify itis accurate. I agree to comply,with all applicable local o;. inances d stat jaws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property '.,' inspec. purp •es. I acknowledge and authorize all information cont fined on this application form , I. to be made available for publi .,+. a Signature'ofApplicant/Age I. -ami A Dates; '//'L /7 - ' IF SUPPLEMENTAL INFORMATIO , SQUIRED I I 1, *New SFD/Second Dwelling Units/Mu tifamily 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 j 1 BldgApp_2017.doc revised 08/0//17 1 . I