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B-2017-1801
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1801 10056 CRESCENT RD CUPERTINO,CA 95014-1012(326 17 035) , COBALT HEATING AND COOLING • SAN JOSE,CA 95123 OWNER'S NAME: IWAHASHI DAVID S AND LINDA G TRUSTEE DATE ISSUED: 10/20/2017 OWNER'S PHONE:408-482-0761 PHONE NO:(408)227-7573 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic.#991115 Contractor COBALT HEATING AND COOLING Date 03/31/2018 X BLDG _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: NEW AC UNIT;NEW EVAPORATION COIL(GARAGE) 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. 2 I have and will maintain Worker's Compensation htsurance,as provided for by (I» Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5600.00 i • 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 17 035 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 agai*t liabilitie. 'r•'ements,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against Cit ' cons,quence of the granting of this permit. / " WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the a.p �j .nderst. ds and will comply with all non-point source regulation. ev,ryjj e :-rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. i Si nature ti g �j` Date 10-20-2017 Issued by:Kim Dunbar Date: 10/20/2017 OWNE Y 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:10-20-2017 • 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 person in any manner so as to become subject to the material. Additionally,should I use equip en or devices which emit hazardous air contaminants as defined by the Ba• •r•- Qua ...0 anagement District d Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu. t . tuartcipal Co.e,Chapter 9.12 • exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S• t! 5-! 25 a,. . ° Labor Code,I must forthwith comply with such provisions or this permit shall �� r . be deemed revoked. Owner or authorized agent APPLICANT CERTIFICATION Date:10-20-2017 I certify that I have read this application and state that the above information is ' I . ST Tie ik. LES.DIk • ► Y 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 10-20-2017 Professional CONSTRUCTION PERMIT APPLICATION 1° + COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r..fl 10300 TORRE AVENUE • , C PERTINO CA 95014-3255 ' U l ..;,,q.....:,-,•.4,k,, (408) 777-3228 • building@cupertino.org PEMIT#B- - // gid r CUPERTINO REVS DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP '❑RE-ROOF ❑SWIMMING POOL/SPA • PROJECT ADDRESS _ '2 APN p 3 2.-K "" 1 �� 03-5 ER NAME P1. 9 M " © \E-MAIL STREET ADDRESS CITY, STATE,ZIP 16t�e b CCze 5 c__EI 0-D C1/43 eec C P. G.5 c 1`& ❑CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE C 7 Q® it a- .\\\6 C._ - ' I STREET ADDRESS CITY,STATE,ZIP I -CA-7-i'P 1(e--L \I-) C� c�7757: rJ J�S� ( Q \ '2-3) E-MAIL PH BUS.LIC a 0 ARCHITECT 0 OWNER.❑OWER AGENT 0 CONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY,STATE,ZIP PHONE DECRII\'Ot� 1 _`i(^,�\L �,�r,� �l�A�c�W"r� �(p 1 L._. �a F.)9 A 1 L J.0 .�` - • 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 A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED . BATHROOM SF SF SF SF 0 DETACHED EXISINC DYES EICHLER IDYES SECOND STORY ADDITION DYES FIRE SPRINKLERS 0 NO 0 NO 0 NO DWELLING SECOND DWELLING DYES 0 ATTACHED DETACHED OTHER UNITS I UNIT ADDITON: 0 NO S F POOLS' 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF ' SPA-SF I SPA ATTACHED OYES 0 NO I TOTAL-SF ' RE pTAL VALU'''-. : Commercial or Buildings with Public 5winunin3 Pools requires Department o(Enpirmvucnhil Heath approval t Q"� I 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 p yEs d OF LAYERS THICKNESS❑5/8" OTHER DOSE ❑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 ;of SQUARES By my signature below I certify to each of th- following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the infor ti. I -ye provided is correct,. I have read the Description of Work and verify it is accurate. I'agree to comply with all applicable local ordi - c_• state law - mg to building construction. I authorize representatives of Cupertino to enter the above-identified property fo iI ii-: .ii . -,.. .cknowledge and authorize all information contained on this application form to be made available for public recor'- q Signature of Applicant/Agent: �1 ` V Dat('a 12a\ ZO C'1 - SUPPLEMENTAL INFORMATION REQUI ED *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 BIdg,4pp_2017.doc revised 08/01//7