B-2017-1837 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1837
19161 ANNE LN CUPERTINO,CA 95014-3537(375 07 011) BARON
CONSTRUCTION&
REMODELING CORP
SARATOGA,CA 95070
OWNER'S NAME: RANCHES FEDERICO D AND CARMEN M DATE ISSUED: 10/26/2017
OWNER'S PHONE:408-489-7691' - PHONE NO:(800)965-2028
_I s. r::_ s I_ ,_.___s. BUILDING PERMIT INFO:.
License Class a Lic.#991076 .
Contractor BARON CONSTRUCTION&REMODELING CORP Date 03/31/2018 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL._COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
KITCHEN REMODEL(268 S.F.);INSTALL 12(N)LIGHTFIXTURES; 1
I hereby affirm under penalty of perjury one of the following two declarations: (N)OUTLET
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 ,
j • rfonnance of the work for which this permit is issued. •
(e-5 have and will maintain Worker's Compensation Insurance,as provided for by
49
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$20000.00
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 375 07 011
.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 Cup-rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST'CALLED INSPECTION.
nature Date 10/26/2017 • Issued by:Abby Ayende •
_... .**11 --- 11°— 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 roofmg material being installed.If a roof is
1. I,asowner 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:10/26/2017 .
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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 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,Sec .1 s 25 I., ,.4 3,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall "
be deemed revoked. ' wner or authorize. •e-n :
APPLICANT CERTIFICATION Date:10/26/2017
I certify that I have read this application and state that the above information is s S _,UC_ s .4WI ING •GE LC_
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.
Signature Date 10/26/2017 Licensed
Professional •
CONSTRUCTION PERMIT APPLICATION
^ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
.p Zo ( _ 15
10 ��ss"°• 408 777-3228 • buildin (I»cu ertino.or� PEMITatB
CUPERTINO REVS DEF#
❑ NEW CONSTRUCTION ID ADDITION ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
•
PROJECT �J APN (� /1_ 01- —r� (
OWNER NAME �^fr'
STREET ADDRESS CITY, STATE,ZIP
6civv' 67 A5 6 roJ-ef CL/Per(I'h0 (' / = q 5 0 --724-
0
❑CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER 2/ LICENSE TYPE- �
.4 1-f- 40 P r� 15,h t rQ ' ) C d (e qqr 4o / 6
ISTREET ADDRESS CITY,STATE, ZIP I
A 1(5-40 3,5 13 5 I'o AAJ . S a r at l G: c c---4 at.Dev 7-C
E-MAILPHON BUS.LIC p
ar'o y,.,c r� G-Inn l'( - co n1 �0 o - c/ 5 9 ® (D-- e lull°
❑ARCHITECT ❑OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT 12 ENGINEER❑DEVELOPER 0 TENANT •
CONTACT NAME E-MAIL I
Cir- c5ara r- • o ron , cn r. 3 rnct, , c0yr
STREET ADDRESS CITY,STATE,ZIP PHONE
4 LIS 40 S,` J 13c,5,./.7 .1trcy sa ►tea i a°l ck c it o $ -ye cf 6 e4 .
DECRIPTON , h
. �<i t c h eco . Y'h o e i r C=->1 c. 9- Lit t<e
•
li;rd /f�cbC�y n ,2--t, �s ! a h d n .et.v T res'' 5 c' LL9'Th
L eVllLily tie 5, t e /' / �9 cry �)� v
e � � �l� ;' n
t��S ✓1 f Y).e- ti/ C r` .f f h J° Are --\. -
LVISINGLE-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(5)
REMODEL i ' REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED .
BATHROOM SF ' SF SF SF ❑DETACHED '
EXISING ❑;YES EICHLER 0 YES SECOND STORY ADDITION O
. NO
FIRE SPRINKLERS❑.NO 0 NO
DWELLING SECOND DWELLING j❑yEs 0 ATTACHED DETACHED OTHER •
UNITS1 UNITADDITON: ❑NO SF I
POOLSI ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF '. SPA-SF . I SPA ATTACH ED ❑YES 0 NO I TOTAL-SF '
R%� TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval 0/-00
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE El NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
' DYES I OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES DWOOD SHINGLES ❑OTHER
*Provide a signed copy 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 property for inspection pur ses. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date: 00'E"
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
•
Brdg,4pp_2017.doc revised 08/01/17
Page 1
F1-; OFFFCE Z_800 965 2028
1EMAIL,BARON CNR@GMAILCOM
WEP::WWW-PAROkqiii;COM
; ,' ADDRESS.14510 BIG BASIN WY SARATOGA CA 95070,
c. Taucr!oro1*9cr. c5unaco L1C#991076
Date: October 26,2017
License: 991076
Letter of authorization:
We authorize Guy Shimon to pull permits and business license 19161 Anne Lane, Cupertino
Guy Shimon is authorized to sign in any document for this matter.
Fein:
464297651
Worker's Comp: Benchmark Insurance Co.
POLICY#:CST5010074
Exp.4/12/18
Thank you,
Amos Boaron.
Abby Ayende
10/26/17
10/26/17
B-2017-1837
Abby Ayende