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B-2017-1023 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO::B-2017-1023 6069 SHADYGROVE DR CUPERTINO,CA 95014-4644(375 40 006) VANNI BROTHERS . CONSTRUCTION REDWOOD CITY,CA • 94062 , OWNER'S NAME: SAUNDERS STEVEN E AND BETTY J TRUSTEE DATE ISSUED: 10/26/2017 OWNER'S PHONE:408-257-9540 • PHONE NO:(650)369-2997 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#537298 Contractor VANNI BROTHERS CONSTRUCTION Date 08/31/2018 X BLDG _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: • IRS FLOOR BATHROOM REMODEL-(50 SF) 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:$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 40 006 representatives of this city to enter updh 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 consequende of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands.a .'will comply with all non-point source regulations per th- - pertino , idipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 11 �//-/ Signatu. ', Date 10-26-2017 Issued by:Kim Dunbar I Date: 10/26/2017 , OWNER-BUILDER DECLARATION I ' 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 4. 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,li 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) I . 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 • t. 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 C+.e,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25 ,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall / be deemed revoked. Owner or authorized agent'LL_ � APPLICANT CERTIFICATION Date:10-26-2017 i I certify that I have read this application and state that the above information is CONS ® CTION LENDING A ENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there i 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 10-26-2017 Professional N CONSTRUCTION PERMIT APPLICATION ND COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinq(a cuoertino.oraP ®� CUPERTINO13• ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# __-- PROJECT ADDRESS L D 6.9 c ke n / C 2'ZoOPVj:-.. D k APN# 3— -so fbob ..... ,_ OWNER NAME �� " N ? "p SPHONE:C& Z5- 95--Tf, E-MAIL STREET ADDRESS /",,6( 5,L��A �i n e DA. CITY,STATE,ZIPco pm((,)o �fc C)IC( FAX CONTACT'NAME (/� 1� /, /(/ l� PHONE E-MAIL!� /U STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ' 0 OWNER AGENT 0 CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR N e LICENSE NUMBER LICENSE TYPE T�UUF..0 ' _ COMPANY Mia .( f 1"U'71" E-MAIL• /rJ.r''P/N7 Q(Ja'Pi// Q Q#r il4 FOS- 7e Z P STREET ADDRESS Wo $ • / Cl� /VL� CITY,STATE 7 p/cel J C 9-.1, e( T O�r� ec- )r^7 ARCHITECT/ENGINEER NAME "C I LICENSE NUMBERBER� (l� BUS.`jLIC# COMPANY NAME 5 f U PIO / 1 E-MAIL yxv�� d(-1`Q( C7M4'� ot FAX STREET ADDRESS ¢jiete:::Y/R9� 1 Pia IIIA 5 / % CITY` T� y q 75 PH04 o81-z 7/2i DESCRIPTION OF WORK " /UY' �/�� `( f C rA=r ( R ex.!.of) L - • EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.Ff. VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH ❑ATTACH DWELLING UNTTS: ISA SECOND UNIT DYES SECOND STORY DYES BEING ADDED? ONO ADDITION? 0 NO ' PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ' IS THE BLDG AN. % YES 1 IZE Ba D x"'x._ f =iwia Ti.9 VIE: PLANNING APPL 14 ❑NO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO 'F.,,-'7-41;,.: ,.,''' '� `,..i,..-4.0,t,',fr,';',',.-.1'� i �C. ¶' 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 ' ••construction. I : _ - -- .tives of Cupertino to enter the above-identified roperty for inspection purposes. Signature of Applicant/Agent: ��LJ;'/PDate: /'2/(7 SUPPLEMENT; ',RMATION REQUIRED sin A `�`m,, WcK Pn Mr Pn f RO GsrP, - '�;. fes'§ '��'�. s Salm rr, - • `tau„,... New SFD or Multifamilydwellings: Apply for demolitionpermit for A � ; " g PP Y �_�o�>ERzr�-coun�rER`�� BurLDrn�c��,AN�rE�uEw� � � I existing building(s). Demolition permit is required prior to issuance of building -1" x S k'T�� i ; *l s permit for new building. '0 EXPREssi>4t�`0' N 31 r"`° PLANNINGPL N EEVJEW . _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure '�C�'STA�ICDARb r ,8 ; , t.p3ti woRI.S n y r `�r kt� form if any Hazardous Materials are being used as part of this project. - 1� ' - '5EARGE aY FIRE DEPT c h _Copy of Planning Approval Letter or Meeting with Planning prior to. ell F =s t s :,� k MA.IOR 1g� �3 SAAITARYSE«ER DISTRICT) submittal of Building Permit application. ,� f ,tgth a fr S' F -,v a Va .r...a `8 j x -lat.;0?,EN'RON MENTA HEALL.TTE .. BldgApp_2011.doc revised 06/21/11 t