B-2017-1886 . CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1886
10352 GREENWOOD CT APT 4 CUPERTINO,CA 95014-3344(369 14 032) XANADU
CONSTRUCTION INC
SARATOGA,CA 95070
OWNER'S NAME: 10352 GREENWOOD LLC DATE ISSUED: 11/02/2017
OWNER'S PHONE:415-519-7187 PHONE NO:(408)892-8402
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#949373
Contractor XANADU CONSTRUCTION INC Date 06/30/2018 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:
UNIT 4-BATHROOM REMODEL(50 S.F.);KITCHEN REMODEL(100
I hereby affirm under penalty of perjury one of the following two declarations: S.F.)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REPLACE SUBPANEL(60 AMPS)-ISSUED 11/14/2017
Compensation,as provided for by Section 3700 of the Labor Code,for the
rte- ormance of the work for which this permit is issued.
- have and will maintain Worker's Compensation Insurance,as provided for by
4r,r. Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. - Sq.Ft Floor Area: Valuation:$18000.00
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'statelaws relating to building construction,and hereby authorize 369 14 032
I• 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
maylaccrue 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 regulati�er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
nature, Date 11/14/2017 Issued by:Abby Ayende
Date: 11/02/2017
OWNER-BUILDER DECLARATION
• I'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
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 oftlie property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/14/2017
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;is 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. ,1 hakfe 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 thatin 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. • er or authorized agent:
APPLICANT CERTIFICATION )ate:11/14/2017
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.
• Licensed
Signature Date 11/14/2017 Professional
r
•
• CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
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10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
k..=.crs,,A_ (408) 777-3228 • buil ding@cupertino,org PEMIT#B- 200- - I
ako
CUPERTINO REV# I , DEF:
, ❑ NEW CONSTRUCTION ❑ADDITION 7ALTERATION ❑T,I, E MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS ' AI N I f7
' tO` 6'2- 42 err MOO Cr .4 • .4q `f -juq r 1(-1,0'JZ
OWNER NAME ��5PHONE E-MAIL
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STREET ADDRESS CITY,STATE,ZIP
t CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
W(Lf iociA,- P.SairCa— .'.6)\)S517--- at tkg 3 1-'3 S
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. STREET ADDRESS CrIY STATE ZIP •
t13g31 TA,�ur l td-I r, firma `-t _ C 9 Som
E-NAIL L PHONE{� BUS.LIC r
4a•1ttlts ��flyt 'rJlrChitYtTUt-Ifla1h„ccv- (C.0V)dg2-.- 02---- �� �
I0 ARCHITECT 0 OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
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CONTACT'N ME ty E— MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DEGRIPTOI' ----.•
tGal_ IAEA. �cUP Ck, M0 - -
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❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY;. '0 INDUSTRIAL`. ❑COMMERCIAL I
EXISG USE EX15TiNG SF NEV,FLOOR SF PORCH SDECKC 'SF DEMO SF !STORMS I TOTAL NET SF 1
TIN
I;, I" 1 I, USE TYPE OCC 5Q.FT VALUATION(5)
,i: II ' I, I 1 1 !
REMODEL; .:. '„ REMODEL 1KITCHEN REMODELOTIM I ' 'GARAGE, 0'ATTACHED — !'i I'i
RATHROOM:SP 5 .SF 5 SF, I 1 !SF; 1I ❑DETACHED 1 •, 1
FIRE1EXISG I 51 RINKGERS Des:No EICHLER, l SECOND ItSTORY ADi iTION; D'5 r. • , I'
DWELLING' SECONDIDWELLINC ❑yES 0 ATTACHED❑DETACHED OTHER:, I, ' I,
UNITS j, UNITAbDRON: (❑NO +1 SF, I ' 11 � � i' ; j
1 i'' n 1 I' r, -
. POOLS I',❑FIBERGLASS 0 VII-,YL`-LINED I 0 GUNITE n PREFABRICATED 1 ':
II
POOL-SFI ' ,.SFA-SF I ' 'SPA ATTACHED:DIVES 0 NO I 1 I TOTAL•SF 1 I r I !
+I'' T+ I I II II II I I ?; I! I 1 RE I IVEED,By: - I, ' �TOIALVALUATION:
Commercial'or EXISTINGROOFTlPEi + BUILT-UP ROOF Fires IIALT43INGLESOWOOD'SHAKESi WOODSHINE ES T E OTHER 1
Maill•Fanrfla.BnlHinis wilt Psitir Siallriw h'i Pools rco ofEiivn omPieninl Hcalh IIsi'of f,,_d
RE-RO dF , [],I, 111. I,.ASPHALT SH1 I nl I, , • ❑ (5PEii; ,
REMOVE/REPLACE[NO IP NO ! ,, I 1 r IDr'i l 318"••' • PLYV1OODTYPE: 1 PITCH: I 2 ROOF CLASS
I PLY11 OOD
„ , D YES, r OF LAYERS THICKNESS j15/Er j OTHER l 0058 ❑CDX OTHER I is I ;I A
i
PROPOSED ROOF TYPE:❑BUILT-UPI ROOF:DASPHALTSHINGLES 0 WOOD SHAKES❑WOCJDSHINGLES ❑OTHER • 111' 1
"Provide,a signed copy;of the!Gupertirio's Te.ar'Off Policy I.I >> III' II I, ! . I ':.II 'I ,' SF j ': I Fof SQUARES
.I II 71 t II.' 1 + i 1,. 11 I
Byy sig atus a b lowion and the each of the D havenprovided;h eo op`t ty'owner]or authorized agent jto act on the property owner's behalf. I
hmy S certify. , g ,
Pp I n I' e i, h,, h3ve,read the DeSCrilp,tion of Wolk alld verifyilit is accurate. I agree
to comply with all'applicable 4o al ordinanlcesiand stateIISHRslrelahng to building construction. I authorize represelifatives of Cupertino to
enter
emad available for dup'opert 'nspll ctiorl purpo les lAcknowledgeIaiid authorize all informaltion containe nlIthi a application form
p 6`ff
Signature of A licant/Agent•. III, ,I' . I I ', III I I' '' I 'Date: I-¢I ! I
PP
SUPPLEMENTAL INFORMATION REQUIRED I 1 ! 'i II II I' '' i i I Ji
11
"New1SFD/Second Dwelling Units/Multifamily Dwellings A Denioliitronpermit Ls.required prior to issuance of a building permIllrit for all new construction.
"Commercial Buildings: Provide a.completed Hazardous MaterialsIDisclosure forin'if,'any Hazardous Materials are being used asllpart of this project.
"'Copy of Planning Approval Letter or Meeting with Planning prior ito submittal of Biulding Permit application. I I 1'
" OA-Provide a letter of approval-from the Home Owner's Association I s. ' I 1
1 1 , 1 Ji I :: . III 'II' 1 r
11 I I 1 II I!III i ' ?` �I
B1dgAj p_2017.doc revised 08/01/17
I I 1
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1886
10352 GREENWOOD CT APT 4 CUPERTINO,CA 95014-3344(369 14 032) XANADU
CONSTRUCTION INC
SARATOGA,CA 95070
OWNER'S NAME: 10352 GREENWOOD LLC DATE ISSUED: 11/02/2017
OWNER'S PHONE:415-519-7187 PHONE NO:(408)892-8402
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#949373
Contractor XANADU CONSTRUCTION INC Date 06/30/2018 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:
UNIT 4-BATHROOM REMODEL(50 S.F.);KITCHEN REMODEL(100
I hereby affirm under penalty of perjury one of the following two declarations: S.F.)
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.
\'2. 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:$18000.00
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 369 14 032
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.
Signature AL-- Date 11/2/2017 Issued by:Abby yende
Date: 11/02/2017
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 fust 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:11/2/2017
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 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. Owner or authorized agent:14i 14.--
APPLICANT CERTIFICATION Date:11/2/2017
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.
Licensed
Signature Date 11/2/2017 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
r : 4 B
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
ST-IDs. ,.
44. r (408) 777-3228 • building@cupertino.org PEMIT PB- 2014— - 188(1
CUPERTINO REV# DEFF
❑ NEW CONSTRUCTION ❑ADDITION 7 ALTERATION ❑T.1. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 1 APN a
tO Sc2— CI(WE'S 11/115P Cri— IPti 4:V q
OWNER NAME WA,VIPHONEt I�_ 5Loll If-MAIL
STREET ADDRESS CITY, STATE,ZIP
CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
wwL,kw, f(-S N)%./— et:N)SG6z e tkg 3 'i--3
STREET ADDRESS CITY STATE ZIP I
c3g31 c&J Lam , 44424W614-- CA" Cl SO;
E-I4AJL PHONE BUS.LIC a
VAkkrag..f �—e.449t '-CACklc",Coit$1 ( t.O I2 g`(02— `"10`-;'S c t
0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT I2 ENGINEER 0 DEVELOPER ❑TENANT
CONTACT N M e. E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
Y-i.FL(E-el i : ' u Pkta E Lc-01-1-c.41.- 4- StArRi e# w ) L{ t JI ' acaC534gj tor-Cs
No Fkt- PSR,/Not
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'51k1-4 ( ("Mut-SS RC(ltf&8') R riot& t't�8( v-Au4e ; cieC-c a•E rexc. cc-+15A—
❑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 A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL ``- REMODELyKITCHEN REMODELOTHR GARAGE ID ATTACHED
BATHROOM SF J SF \O SF SF ❑DETACHED
EXISTNG ❑YES EICHLER 0 YES SECOND STORY ADDITION DYES
FIRE SPRINKLERS❑ NO ❑ NO ❑NO
DWELLING SECOND DWELLING ❑yEs ❑ATTACHED❑DETACHED OTHER
UNITS A UNIT ADDITON: ❑NO S F
POOLS ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED ID yes ❑ NO I TOTAL-SF
RECEIVED BY: TOL VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath avvrona7 j////11��jnl'Ok' aMV
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHING ES❑T E OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IF NO PLYWOOD 01" ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
0 YES OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 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 prop t nspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public r
Signature of Applicant/Agent: Date: 111. tL'Z-IT -
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