B-2017-1830 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1830
10200 EMPIRE AVE CUPERTINO,CA 95014(326 23 045) BEYOND BUILDERS
• SAN CARLOS,CA -
94070
OWNER'S NAME: RUGGIERO ERIC DATE ISSUED: 10/26/2017
OWNER'S PHONE:650-544-4478 PHONE NO:(650)544-4478
•
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
License Class B Lic.#953381
Contractor BEYOND BUILDERS Date 10/31/2018 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:
(N)TEMPORARY POWER POLE(100 AMPS)
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
ompensation,as provided for by Section 3700 of the Labor Code,for the
e-rformance of the work for which this permit is issued.
1 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:$400'.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 andcounty ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 23 045
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 er the Cupe ' Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
ure. Date 10/26/2017 Issued by:Jasmine Archbold
Date: 10/26/2017
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 stricture 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: 10/26/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. .1 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. II 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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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, ections 2550 ,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
;be deemed revoked. R, e;c r authorized agent:
APPLICANT CERTIFICATION Dd—. 10/26/2017
I certify that I have read this application and state that the above information is CONSTRUCTION L DING 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 •
consequehce 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 10/26/2017 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
:\4011," •, -' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
. 10300 TORRE AVENUE • CUPERTINO CA 95014-3255
...,:q.,..-{ ' (408) 777-3228 • buil din Ocupertino.org PEMIT»B- 2 t7 t 7 '- le'-'- v
CUPERTINO REV a DEF#
❑ NEW CONSTRUCTION ['ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS It wV IE ✓ u-e_ APN k 2--C. . — Zr —O�5
OWNER NAME PHONE E-MAIL
F7 o� 1 `�4p;t'/z, Cosh—i li-1/�--91 :9
STREET ADDRESS - ✓ CITY, STATE,ZIP
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WOONTTRACTOR NAME.- ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE
LICENSE TYPE
ISTREETADDRESSF-4-t-c p�5v ' �-e U+� c.>\ CITY,STATE, ZIP 9��3 a I�
S(� gref In .p • Sc., Cif� CA- 9—f671 • I
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❑ARCHITECT ❑OWNER OWNER AGENT CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER El TENANT .
CONTACT NAME��� � �� E-MAIL V l
STREET ADDRESS �� CITYYY,f�/STATE,ZIP PHONE
DECRIPTON
'riALr— ro'-e- 00.4
., ,
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 B TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE
❑ATTACHED
BATHROOM SF SF ' SF SF 0 DETACHED
EXISiNG 0YE5 EICHLER 0 )-;ES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO 0 NO ' -0 NO
DWELLING SECOND DWELLING D YES D ATTACHED 0 DETACHED OTHER
UNITS O UNIT ADDITON: - ❑NO j S F
POOLSI ❑ FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED .
POOL-SF SPA-SF . I SP, ATTACHED❑YES 0 NO - 1 TOTAL-SF
N.,..,il'0,4;iii
RECEIVED BY: TOTAL VALUATION:
Commercial or Multi-Family Bnildi»qs with PublicSwhu,uine Pools requires Department ooEnvirmnnenlal Heath apvrovah ' .-- _ LOU
RE-ROOF
EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) -7
REMOVE/REPLACE❑Np I IF NO j PLYWOOD ❑1„ D 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES F OF LAYERS THICKNESS❑5/8" OTHER 120513 ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT''-LIP ROOF 0ASPHALT SHINGLES 0 WOOD SHAKES DWOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF Fof 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 die 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 inspec ...in purpo s. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: — ✓ �n Date: /0/2-4/17
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
BldgApp_2017.doc revised 08/01/17