B-2017-1746 •
CITY OF CUPERTINO BUILDING PERMIT .
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1746
10865 SWEET OAK ST CUPERTINO,CA 95014-0122(326 51 037) M G CONSTRUCTORS .
&ENGINEERS INC
MORGAN HILL,CA
9503'7
OWNER'S NAME: GEHRE ALMA E TRUSTEE DATE ISSUED: 10/30/2017
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OWNER'S PHONE:408-398-2523 PHONE NO:(408)842-5599
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#642058
Contractor M G CONSTRUCTORS&ENGINEERS INC Date 07/31/2019 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:
REMOVAL OF 5 FEET STORM PIPE AND CAP(E)STORM DRAIN
I hereby,affirm under penalty of perjury one of the following two declarations: -
t. 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
i performance of the work for which this permit is issued.
Q" 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:$600.00
APPLICANT CERTIFICATION
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I certify that I have read this application and state that the above
information is correct.I agreeto comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building,construction,and hereby authorize 326 51 037
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 d will comply with all non-point .
source regulati .er the Cupertino nicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION..
I
ignatur:-� 4" Ihk, Date 10-30-2017 Issued by:Kim Dunbar
Date: 10/30/2017 '
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
t. I;as owner of the propeirty,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:
' con'tractors,to construct the project(Sec.7044,Business&Professions Code). Date:10-30-2017
I hereby affirm under penalty'ofperjury.one of the following three declarations:
t. ' I'.have arid will maintain a ertificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided fori 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
Sectioti13700 of the,Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.. I will
permitis issued., maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
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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'ariy'manner so as to become subject 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 td,the Worker's Compensation provisions of the the Health&Safety Codes= ions 25505,25533,'a.25534.
. Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed r"evoked, Owner or au : ' ed agent: , i•�2�_ -----"mow
��=
APPLICANT'CERTIFICATION Date: 10-30-2017
I certify that I..have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.'/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 tliegranting Of thislpermit. Additionally,the applicant understands '
and will comply with all non pomt'source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 I understand my plans shall be used as public records.
Licensed .
Signature Date 10-30-2017 Professional
CONSTRUCTION PERMIT APPLICATION •
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
..(1.0
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
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s (408)777-3228 • building@cupertino.org PEMIT#B- 2°) - 11-1(6*
CUPERTINO- REV u DEF i+
❑NEW CONSTRUCTION ❑ADDITION ALTERATION ❑T.I. ❑MEET 1:RE-ROOP ❑SWIMMING POOL/SPA
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0 ARCHITECT ❑OWNER ❑OWNER AGENT'I CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
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INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF'DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF SF SF - SF [l DETACHED
EXISING ' 0 NOS EICHLER 0 YES SECOND STORY.ADDITION EYES
NO
ERE SPRINKLERS '
DWELLINGISECONDDWELLING ❑YES DATrACHEDD DETACHED OTHER
IIS: 1UNITADDIFON: 1:1 No SF
POOLS! 0 FIBERGLASS 0 VINYL-LINED ❑'GUNITE ❑PREFABRICATED
POOL-SF SPA-SF ] SPA ATTACHED BYES LI No TOTAL-SF
RETEk 7:17 x I TO" vA AT5 jl
Commercial or Multi-Familu Buitdings with Public Swimming Posts requires Dcpertmeni of Environmental Heath nvuraVai )_: r 77 /k..Ut-''
RE-ROOF EXISTING ROOF TYPE: 0 BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES 0 WOO* 111FGLES D TILE OTHER(SPECIFY)
REMOVE/REPLACE Q NO 1 IF NO PLYWOOD ❑W' ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
I i]Y&5 s OF LAYERS THICKNESS 0 5/8" OTHER ❑OSE ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUH.T-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy of the Cupertino's,Tear-Off Policy SF Rof 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 inspec•. • 0 oses, I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent" 7.I • Date: !O/I I 113
SUPPLEMENTAL INFORMATION REQUIRED
*New SPA/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 Owners Association
tee.
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BldgApp_2017.doc revised 08/01/17