B-2017-1898 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1898
7920 FALL CT CUPERTINO,CA 95014-4114(362 13 008) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: SMARTT JOANNE TRUSTEE DATE ISSUED: 11/03/2017
OWNER'S PHONE:408-253-1247 PHONE NO:(925)872-7326
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#817040
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2019 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 a . effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION-CLOSET)
I hereby affirm and, penalty of perjury one of the following two declarations:
1. I have. d will maintain a certificate of consent to self-insure for Worker's
Com. nsation,as provided for by Section 3700 of the Labor Code,for the
pe •ormance of the work for which this permit is issued.
ave 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:$9517.00
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 13 008
representatives of this city to enter upon the abov=•mentioned property for
inspection purposes. (We)agree to save in.- nify and keep harmless the
City of Cupertino against liabilities,judg ts,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in cons ence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant unders ds and will comply with all non-point
source regulations p the Cu. ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
v'
Signatur Date 11/3/2017 Issued by:Jasmine Archbold
Date: 11/03/2017
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 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:11/3/2017
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 ich emit hazardous
air contaminants as defined by the Bay Area Air Quality anagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municip• C.. , • .a '.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,'•c iori 25505 55.3,and/2.•
Labor Code,I must forthwith comply with such provisions or this permit shall AC--
be deemed revoked. Owner or authorized agents4111Pf
APPLICANT CERTIFICATION Date: 11/3/2017
I certify that I have read this application and state that the above information is I t s► LENDI A d(gl'
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 11/3/2017
/ CONSTRUCTION PERMIT APPLICATION
\r,,,,,,,,/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertino.org PEMIT zB-Z (4 - t S°tf
CUPERTINO REVS DEFE
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION E T.I. ❑MEP E RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS-9q2 r.:4
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ACQNTRACTOR NAME 0 OWNER-BUILDER COl` ANY NAME LICENNS/SE}J/NUMBER
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DECRIPTON
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63D3GLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
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 REMODEL KITCHEN REMODEL OTHR GARAGE D ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
•
EXISING
SPRINKLERS 0 NO YES EICHLER 0 YES SECOND STORY ADDITION ❑YES
FIRE
0 NO
DWELLING SECOND DWELLING D YES D ATTACHED DETACHED OTHER
UNITS II UNIT ADDITON: ❑NO S F
POOLS) 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF
CEIVED BY: TO L VALUATIO
Commercial or Multi-Familu Buildings with Public Swimming Pools respires Department of Environmental Heath approval 3 ti�_ '' 1 ,` �/�
is
RE-ROOFI EXISTING ROOF TYPE: D BUILT-UP ROOF E ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SACIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1„ ❑3/B" ' PLYWOOD TYPE: PITCH: ROOF CLASS
0 yS r OF LAYERS THICKNESS❑5/8" OTHER Dose ❑CDX OTHER •12 A
PROPOSED ROOF TYPE:OBUILT-UP ROOF DASPHALT SHINGLES D WOOD SHAKES DWOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF rot SQUARES
By my signature below I certify to each of the following: I am the property owner or authorized agent t ct on the property owner's behalf. I
have read this application and the information I have provided is correct. I have read the Description Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relating to building construction. authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. I acknowl authorize all ' ormation containe on tls application form
to be made available for public record. 7/ /
/�-y,
Signature of Applicant/Agent: Date: / J -
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