The URL can be used to link to this page

B-2017-2026 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2026 22408 BALUSTROL CT CUPERTINO,CA 95014-3948(356 03 019) AFFORDABLE WATER . HEATERS AND . PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 . OWNER'S NAME: KINNEY EDWARD E JR AND KAY B TRUSTEE DATE ISSUED: 11/27/2017 OWNER'S PHONE:408-252-1956 PHONE NO:(855)345-9087 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB 09/30/2018 _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 JOB DESCRIPTION: license is in full force and effect. REPLACE WATER HEATER 40.GAL(SAME LOCATION) I hereby affirm under penalty of perjury one of the following two declarations: _.4 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. r . ii have and will maintain Worker's Compensation Insurance,asilli 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:82980.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: • ' information is correct.I agree to comply with all city and county ordinances 356 03 019 and state laws relating to building construction,and hereby authorize , representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to'save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally,the.i,,:i�,,:yy'cant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulat'.nT-r the Cupertino Municipal Code,Section 9.18. • Issued by:Kim Dunbar Signature ® , Date 11-27-2017 Date: 11/27/2017 OWNER-BUILD R D ECLARATION RE-ROOFS: I hereby affirm thai exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons. installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will dothe work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I',as owner of the property,am exclusively contracting with licensed Date: 11-27-2017 contractors to construct the,project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the '2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous a. I certify that in the'performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with th• upe tino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Cot e, ec tons 05,25533,and 25534. exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall Owner be deemed revoked. Owner or authorized agent: iLr1 Date:11-27-2017 APPLICANT CERTIFICATION ONSTRU IYL!]► LE `t'ING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a coion lending agency for the performance correct.I agree to•comply with all city and county ordinances and state laws of work's for which this permit is is -,. (Sec.3097,Civ C.) relating to buildingconstruction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep:harmless the City of Cupertino against liabilities, Lender's Address judgments,cost's,and expenses which may accrue against said City in consequence of ttie-granting of:this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply.with all non point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. ' CONSTRUCTION PERMIT APPLICATION • ~ t COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION .q;+` 10300 TORRE AVENUE • CUPERTINO, CA 95014-325 • 5 tlss go ;r: ;?.,:,-;." ' (408) 777-3228 • buildingc©cupertino.orr PEMIT,=B- <et( 7- _1.._ Z CUPERTINO REVF DEFx • ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. MEP ❑RE-ROOF ❑SWIl\WING POOL/SPA PROJECT ADDRESS SalartA N 1 sio • OWNER �`�� PHO q �� n��' I ^��E-MAIL • STREET ADDRESS `/'tom ,STATE,ZIP W/ - _ .--.- ---- ---._13dYs ..----C4--. �. ...O, _ .S_1_ ----------- CONTRACTOR NAME ❑OWNER-BUILDER C,MP 1 NAM LICENSE NUMBER LICENSE TYPE -Se "7 34 i id 41- - Ia, ,2 .73Ld' -, STREET A••'ESS ATE, ZIP i c-^ E-MAIL9S g;ff to vis'keArinio gi) i p ,,, nPHON BUS.,LIC A b �x �w i �rn �0/)<93 1 16 4604SZ • ❑ARCHI ❑ A'NER.❑OWNER AG T 0 CONTRACTOR.AGENT❑ENGINEER 0 DEVELOPER 0 TENANT , ' CONTACT NAME E-MAIL • ' STREET ADDRESS CITY,STATE,ZIP PHONE DECRIPTON 14,4--e.rfr, +1 deV6v) • k <LI--e-� Ile 41 1 • ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I 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 REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF • , SF SF SF 0 DETACHED EXISING ❑YES ' EICHLER DYES SECOND STORY ADDITION O YES FIRE SPRINKLERS❑NO' ❑ NO NO , DWELLING SECOND DWELLING 0 'ES 0 ATTACHED DETACHED OTHER UNITS A UNIT ADDITON:. ❑n0 S F POOLS( 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF • RE 5 QED B : TOTALV�A,LUA T I ION: • Cnnnuereinl m•.Mrthi=Fahrihr Buildings with Public Swinuvinr Pools rrrnrires Dcnartmr»t ofEnvirnnnrrnhil Heath(mama! A 1� ,/1` _ 2 L V L RE-ROOF EXISTING ROOF TYPE: Q BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE 0 NO IF NO PLYWOOD 01' ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS DES AOF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER .12 A 'PROPOSED ROOF TYPE:,❑BUILT-UP ROOF DASPHALT SHINGLES ❑WOOD SHAKES DWOOD 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 infor ation save provided is correct. I have read the Description of Work nd verify it is accurate. I agree to comply with all applicable local ord'.: ante . state laws relating to building construction. I author•z representa Yes of Cupertino to enter the above-identified property fo, . .urposes. I acknowledge and authorize all informati /c ntaii e o, t is plication form to be made available for public recur. Signature of Applicant/Agent: , Date: 4 SUPPLEMENTAL INFORMATION R a IRED ' *New SFD/Second,Dwelling':Units/Mu tif.mily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a co ,p -ted Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or eeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owner's Association • • BIdg.9pp_2017.doc revised 08,'01i17