B-2017-1840 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1840
7635 HOLLANDERRY PL CUPERTINO,CA 95014-5070(362 26 068) NEWHOME •
CONSTRUCTION
. FREMONT,CA 94539
OWNER'S NAME: PAUL DEBJYOTI AND SHAH DIMPLE TRUSTEE DATE ISSUED: 10/27/2017
OWNER'S PHONE:408-489-1971 PHONE NO:(408)421-9808
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
•
License Class B Lic.#832709
Contractor NEWHOME CONSTRUCTION Date 02/28/2018 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
I hereby raffirm 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
Compensation,as provided for by Section 3700 of the Labor Code,for the •
of the work for which this permit is issued.
,mormance
ave and will maintain Worker's Compensation Insurance,as provided for by
tion 3700 of the Labor Code,for the performance of the work for which this
permit is issued. '071-- Sq.Ft Floor Area: Valuation:$1200.00 •
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 362 26 068
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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
mature �� Date 10/27/2017 Issued by:Abby Ayende
Date: 10/27/2017
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,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:10/27/2017
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,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ner or authorized agent:
APPLICANT CERTIFICATION alb ate.:10/27/2017
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. •.
Signature Date 10/27/2017 Piceessd
Professional
CONSTRUCTION PERMIT APPLICATION
iii&' .4.-
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 .
�Z4t1➢�' � (408) 777-3228 • buildingr'cupertinO.org PEMITB- I u `�
CUPERTINO REVS DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF El SWIMMING POOL/SPA
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CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENS PE •
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CONTACT NAME 1) l5 13 .IT Or 1 pko L E-MAIL e ,I;,,L,,f /)/ �y�,��I),• ,/�L9,I4 ,
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it INGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
IEXISTING:USE EXISTING SF,NEW FLOOR SF PORCH SF DECK SF DEMO SF .STORIESa TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
1 1
.REMODEL , REMODEL KITCHEN REMODELOTHR . GARAGE ❑ATTACHED
'BATHROOM.SF SF SF SF 0 DETACHED
EXISING I ! ❑YES EICHLER. ❑ YES SECOND STORY ADDITION DYES '
FIRE SPRINKLERS❑ NO , ❑,NO 0 NO
DWELLING SECOND DWELLING„ 0 YES 0 ATTACHED:DETACHED OTHER
UNITS,i' 1 UNITADDITON: 0N SF
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POOL ❑S( :❑FIBERGLASS VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF . SPA-SF II SPA.ATTACHED ❑YES 0 NO l TOTAL.-SF I
C " c RECEIEDBY: ,n-& TOV(aL�l(}�ION:
Commlrr.I multi-Family Burldmgs iirith Publir�Swinuniuq Pools requires Dennrtment f Envirougreulnl Heath auuroval (Id ,1 'VV` /�(Jl!l Jl
RE-ROOF EXISTING ROOF TYPE 'Q BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES[1 WOOD SHINGL ❑TILE OTHER(SPECIFY)
RMVE! EPLACE 0 NO, ;,IF NO PLYWOOD ❑rh 03/8" PLYWOODTYPE: PITCH:
ROOF CLASS
I EYES R OF LAYERS _ THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
• Provide assigned copy of the Cupertino's Tear-Off Policy SF vol SQUARES
By•rriy signature below I:certify:1W 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 purpose I a knowledge and authorize all information contained on this application form
to be made available for public'record. �} 'IM
t 2
Signature of Applicant/Agent: . ' �tl U�c P'IMDate: / /
SUPPLEMENTAL INFORMATION REQUIRED
*(jewi SFD/Second Dwelling;Units/IvIultifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
'Comimercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materialsare 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 fi•oin the Home Owner's Association
'
BldgApp_2017.doc revised 08/01/17