B-2017-1953 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1953
854 ALDERBROOK LN CUPERTINO,CA 95014-4614(369 17 022) GAGNE BROTHERS
ENTERPRISES INC
NOVATO,CA 94949
OWNER'S NAME: WOODSON MERYL L TRUSTEE DATE ISSUED: 11/14/2017 •
OWNER'S PHONE:408-858-1363 • PHONE NO:(415)763-4002
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class A:C-36 Lic.#857357
Contractor GAGNE BROTHERS ENTERPRISES INC Date 04/30/2019 X BLDG _ELECT X 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:
REPLACE UPPER LATERAL AND INSTALL PROPERTY LINE CLEAN
I hereby affirm under penalty of perjury one of the following two declarations: OUT
is I have and will maintain a certificate of consent to self-insure for Worker's
if Compensation,as provided for by Section 3700 of the Labor Code,for the
eerformance of the work for which this permit is issued.
ry t;. 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:$13700.00
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 17 022
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,t • app •ant understands and will comply with all non-point
source regu:tions pe the Cupertino Municipal Code,Section 9.18. ' 180 DAYS FROM LAST CALLED INSPECTION.
S.t -�.. Date 11/14/2017 Issued by:Abby Ayende
. 17.. glOW • Date: 11/14/2017
OWNER BUILDER DECLARATION
I hereby affirm that:I ant 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: 11/14/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and wilt 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 wily 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(x)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 t • -r, tino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety ode,Sections 25505,25533,and.25534.
Labor.Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. doot[Finer or authorized agen 4111110,
APPLICANT CERTIFICATION Date: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 andkeep 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
•
CONSTRUCTION PERMIT APPLICATION
-r g COMMUNITY DEVELOPMENT DEPARTMENT •• BUILDING DIVISION
,,,, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
.,tlrs\ (408) 777-3228 • building@cupertino.org PEMITriB- 120 q-- - �� 3
CUPERTINO REVS DEFE
•
❑ NEW CONSTRUCTION El ADDITION ❑ALTERATION E T.I. ❑MEP E RE-ROOF 11 SWIMMING POOL/SPA
PROJECT ADDRESS ppS R eXtr��(• '� l �APN I bug_ n- -On Ln_
Ow �4/`� V n • (T v.�AJv L 1
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ADDRESS CITY, STATE,ZIP•
TeCONTRACTOR NAME 0 OWNER-BUILDEIT COMPANY NAME LICENSE NUMBER LICENSE TYPE
, Vo\c---0 5 13en f'fall ktAVorwa-2
TRES �1 i 1"'j vu • 3 r� `E, ZINC P s� cm 1/L c 1
E-MAIL • PHONE ',WGBUS.LIC A
Li MCG-T
0 ARCHITECT 0 OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
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CONTACT NAME b E-MAIL
•
STREET ADDRESS y� CITY,STATE,ZIP PHONE
DECRIPTOp
Ct, ae. 0A0 V)e\r Catr-11C-OLA A- Ne),JJ 'er-ND Or1Q
tic •
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTINGSF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION.(5)
•
REMODEL REMODEL KITCHEN REMODEL OTHR • GARAGE 0 ATTACHED
BATHROOM SF SF SF SF D DETACHED
EXISIEICHLER 0
YES SECOND STORY ADDITION
FIRESPRINKLERS 0 NO 0 O NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER -
UNITS r UNITADDITON: ❑Nip SF
,POOLS 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL,SF
• RE IVSD
BY:a., VALUATION:
Commercial or Multi-Familu Boildiars with Pnblir Swimminp Pools rendres Denanlment of Environmental Heath anvronaf I 1TQTAL� 0
E
R -ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF Q ASPHALT SHINGLES D WOOD SHAKES❑WOOD SHINdLES D TILE OTHER(SPECIFY)
REMOVE/REPLACED NO IF NO PLYWOOD ❑'"" ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
DYES e OF LAYERS • THICKNESS❑5/8" OTHER Doss ❑CDX OTHER '12 A
PROPOSED ROOF TYPE:❑BLTLT-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 i -.rmatio,I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
' to comply with all,applicable locr, ordinance• and state laws relating to building construction. I authorize representatives of Cupertino to
' enter the above-identified prope,•y'f. inspect on purposes. I acknowledge an. . .r--i.ze all information contained on this application form
to be made available for,public r-c. d.
Signature of Applicant/Agent: Date: 114 "'6 GTh
,SUPPLEMENTAL INFORMATION RES IRED
*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 PlanninggApproval Letter'or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a'letter of approval from the Home Owner's Association
t
•
Bldg,9pp_2017.doc revised 08/01/17
�ot,51 VS IPAR,.o'�' `,\,s,
CUPERTINO SANITARY DISTRICT CI t; CS0
20863 Stevens Creek Blvd#100, Cupertino, CA 95014 4s !yc
Tel(408)253-7071 • Fax(408)253-5173 ''S'4atrsuac'9 CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counter)
(Single Family Project n Multi-Family Project n Commercial Project
Project Address: _ C6 5 y A-(ol:Q. 6►"-ook_ Lc,1A__c__ ` .Aft 3(0ci - I )-07 z.-
Permit
Permit Number: 13-1,0n-- RS3
Scope of Work:` r tact u P p &- (ot-—Q-r- Lci p i-ko
. Owner/Applicant Name: ,,,Jc—>1„;wu Lt't I ?(t,c bil Phone:
L-(l 5- 74-7- —7.&-0(
Address:
Date: 01140.- -- Prepared By: 06t
Ci y Authorized Representative
I, as property owner or authorized agent, .• no ' -dge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior t. the approval of final inspection for proposed project.
Date: \` 1;CA l Signature:
Owner/Authorized Agent
:CUPERTINO SANI A •Y DISTRICT OFFICE USE ONLY
n Pre-inspection Required - Final Inspection Required
Date Scheduled:
Date: Conditional Approval By:
Authorized Representative
Cupertino Sanitary;District
District will notify owner of the required fee within 5 days after Pre-Inspection has been completed and cc
City of Cupertino.
Yr Inspection Fee Paid Date Paid: 1 ( - I(-I-—17
Inspection Fees:
yel $250/unit- Single Family Residential already connected, but new cleanout is required
0 $150/unit- Single Family Residential already connected with existing cleanout in working order
ED $350 Minimum—Commercial and Retail Actual Amount:
0 $200/each—Disconnect and/or abandon lateral service
Connection Permit Fees:
= $350/unit- Single Family Residential connecting to existing lateral
0 $650/unit—Single Family Residential connecting with new lateral
0 $100/unit—Multi, Hotel, Living Units, etc. Actual Amount:
0 $500/connection-Commercial and Retail Actual Amount:
Connection Use Fees(See Attached Calculation Sheet):
D Area and Frontage Fees Amount:
0 Residential Excess Fees over 3.5 unit/acre . Amount:
0 Commercial and Retail Connection Fees Amount:
0 Commercial and Retail Change in Use.Fees, Amount:
Date: I t- 14- 17 Final Approval By: _j.
J Authorize resentative
Cupertino Sanitary District