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B-2017-1946 • CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1946 1124 KENTWOOD AVE CUPERTINO,CA 95014-5808(359 31 059) TERRACOTTA CONSTRUCTION INC SAN JOSE,CA 95132 OWNER'S NAME: WELLS FARGO BANK N A TRUSTEE DATE ISSUED: 11/14/2017 OWNER'S PHONE:408-250-2798 PHONE NO:(408)431-6889 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#920167 • Contractor TERRACOTTA CONSTRUCTION INC Date 10/31/2018 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: KITCHEN REMODEL(96 S.F.);MASTER AND GUEST BATHROOM • I hereby affirm under penalty of perjury one of the following two declarations: REMODEL(75 S.F.) 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 ellgtformance of the work for which this permit is issued. 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 359 31 059 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. • nature Ol117 1\* Date 11/14/2017 Issued by:AbbyAyende Date: 11/14/2017 OWNER-BUILDER DECLARATION • ' 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 dothe 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 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 1 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 beconie;subject to the Worker's Compensation provisions of the the Health&Safety Cfak Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall _ be deemed revoked. Oli'C—wner or authorized agent: 101.�jN—kki IP) 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 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 grantingof 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 11/14/2017 Licensed • Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION NW 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • a - r��' .�s";D:`,r rs `�l Q (408) 777-3228 • buildings-cupertino.or� PEMIT NB- �© CUPERTINO REV# DEFE El NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.T. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS , / APN a e ' 6t/n—' 112 - K-Qv1�cvxxx� /� �{��,.(,�`,�v—J r`� 1 (,JL OWNER YICO,NAME M\CSA12. �CAV �4ki 6 "c , PHONEY V'IGD 2 2 1 E-MAIL STREET ADDRESS CITY, STATE,ZIP �bM 11.2-4 K-ev'vwoc ki C....\=,z_A-wko Ca. ' PCONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME ' LICENSE NUMBER LICENSE TYPE • )UL.10 V,\‘1� Te Cc * 92-Dk6-- '\amu STREET ADDRESS I CITY,STATE, Z ' E-MAIL PHONE BUS.LIC# calrc�.� CCON4 t ac).ccw>, 008) 431-BSER tiro-&1'1 1°131 ❑ARCHITECT 0 OWNER ❑OWNER AGENT EICONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E-MAIL • STREET ADDRESS CITY,STATE,ZIP PHONE DECRIPTON ' 1<t>c-C\c tv 'C-jc� i F1Nvcc W\ avlA TAc cAf ' n�e xv' <It_vv c& 1 • \ r \,, . . TISINGLE-FAMILY/DUPLEX.!;0 MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW,FLOOR SF PORCH SF DECK SF ``5DEEM�MO SF STORIES; TOTAL NET SF USE .TYPE OCC SQ.FT. VALUATION(5) REMODEL G;le7:7.4. REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED BATHROOM SF A511-3 ✓� SF I�, alb 0 SF 0 r'1 SF ❑DETACHED 4 I a C EXISTNC ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS 0 NO 0 NO - •❑NO DWELLING SECOND DWELLING! 0 YES' 0 ATTACHED DETACHED. OTHER UNITS O UNIT ADDITION: ❑NO 5 F POOLS' ❑FIBERGLASS 01 VINYL-LINED ❑GUNITE ❑PREFABRICATED POOL-SF SPA-SF I, SPA ATTACHED AYES 0 NO I TOTAL-SF RECEID BY: TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swinnuir4 Pools requires Department of Environmental Heath approval 11, p- kA (1 i?Alm Ave toD,D -o O RE-RO OFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF E ASPHALT SHINGLES[]WOOD SHAKES WOOD SHINGLEN 0 TILk OTHER(SPECIFY) REMOVE/REPLACE Q NO IF NO I PLYWOOD ❑ie ❑3/8" PLYWOOD TYPE: PITCH: , ROOF CLASS DYES FOFLAYERS THICKNESS❑5/8" OTHER El OSB ❑CDX OTHER '12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy 5F AoF 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(proper for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public c rd.cc.�, (� Signature of Applicant/Agent: V 1-V, ` -WOc5 Date: 1.kr f i-(z' t - SUPPLEMENTAL INFORMATION REQUIRED t *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 - Bldg,4pp_2017.doc revised 08/01/17