B-2017-2020 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2020
20084 NORTHWIND SQ CUPERTINO,CA 95014-0552(316 38 056) ROOTER HERO
PLUMBING INC
MISSION HILLS,CA '
91346
•
OWNER'S NAME: DENENBERG MICHAEL S AND BERNADINE B TRUSTEE DATE ISSUED: 11/22/2017
OWNER'S PHONE:831-901-4291 PHONE NO:(888)929-4376
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: .
License Class C-36 Lic.#973014
Contractor ROOTER HERO PLUMBING INC Date 05/31/2018 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:
DRAIN LINE REPAIR(BATHTUB),SEWER LINE REPAIR BUILDING
I hereby affirm under penalty of perjury one of the following two declarations:
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. •
i.� 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:$6064.00
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 316 38 056
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 r the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature . ,e/J-2. �-------le
Date 11-22-2017 Issued by:Kim Dunbar
Date: 11/22/2017
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 ofthe 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)
z. 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: 11-22-2017 .
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,df 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
Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I ,
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 1
•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,Sec' ! 25505,25533, nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall : c
be deemed revoked. , •
Owner or authorized agent: /�
APPLICANT CERTIFICATION Date:11-22-2017 V I•,
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 11-22-2017 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
,-A.' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
z431 (408) 777-3228 • buildingClcuIertino.org PEMITrB-� - 7.-6
CUPERTINO Qq REV# DEF a;
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CONTRACTOR NAME. ❑OWNER-BUILDER COMPANY NAM LICENSE NUMBER ' LICENSE TYPE
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0 ARCHITECT 0 OWNER.0 OWNER AGENT/ _�cONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT J, '
CONTACT NAME , , E-MA
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IDECHPTONS "I
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❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR'SF PORCH SF I DECK SF DEMO SF STORIES a TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED '
BATHROOM SF SF SF SF 0 DETACHED •
I
FIRESPRINKLERS❑ NO EICHLER 1'NO SECOND STORY ADDITION ONO
DWELLING SECOND DWELLING 0 ygs.0 ATTACHED DETACHED OTHER
UN1TSq UNIT ADDITON: ONO SF
POOLS 0 FIBERGLASS ❑'VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I. SPAATTACH ED❑YES 0 NO I TOTAL-SF
REC I OO1 a //// TQTALVALUATION:
Commercial or Muhiam
i-Famihu Buildings with Public Smimmine Pools requires Devartmenl of Heath avvroval lJ�7J.�/ Is j I' . �J//- J 19
RE-ROOF EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE Q NO IF NO PLYWOOD ❑1/2"
❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
EYES ?OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT 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 ordinanc-. . d state laws re ting to building construction. I authorize representatives of Cupertino to
enter the above-identified property for ii - esti. purposes. I a nowledge and authorize all information contained on this application form
to be made available for public record rr
Signature of Applicant/Agent: 4 e_<,,........-4.--
`r-......-4.-- Date: /1". iZ? 'I -
SUPPLEMENTAL INFORMATION REP 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 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 08/01117 -