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B-2017-2031
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2031 19161 ANNE LN CUPERTINO,CA 95014-3537(375 07 011) FANTASTIC ROOTER INC ' GILROY,CA 95021 OWNER'S NAME: RANCHES FEDERICO D AND CARMEN M DATE ISSUED: 11/27/2017 OWNER'S PHONE:408-868-4551 • PHONE NO:(408)767-1355 • LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lic.#905744 Contractor FANTASTIC ROOTER INC Date 10/31/2019 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: , REMOVE WATER HEATER FROM(CLOSET);REPLACE WITH I hereby affirm under penalty of perjury one of the following two declarations: TANKLESS WATER HEATER(EXTERIOR OF HOUSE) 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 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:$4700.00 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 • - 375 07 011 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,Ithe 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. 7 ature 1'�(V01 11/27/2017 Issued by:Jasmine Archbold Date: 11/27/2017 OWNER-BUIdDER.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,gas 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 Iinspection. compensation,will'do the work;and the structure is not intended or offered for 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: 11/27/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. l'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 wbrk 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 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 3. i 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 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 become subject to the Worker's Compensation provisions of the the Health&Safety Cod• .ections 25505,25533,and 25534. • Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. arrACr.r authorized agent: Ill IA APPLICANT CERTIFICATION b.te: 11/27/2017 , // I certify thatil have read this application and state that the above information is CONSTRUCTION DING AGENCY correct.I agree to comply with all city and county ordinances and state laws - I hereby affirm that there is a construction bending agency for the performance relating,td biiilding'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, r 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. Signature'i'I: ' Date 11/27/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION „,C ` 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • ;,,,,,R,,,,,,,,,,r,,,, (408) 777-3228 • buil ding@Icupertino.org PEMIT,B- Zj ( 'jr _ 1-03 1 CUPERTINO - REVS DEFE ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP E RE-ROOF �❑SWIMMING POOL/SPA PROJECq APN A 1 I0( n-2 \ / , $15 `.�1-ot 1. OWNER NAME PHOIE • E-MAIL STREET ADDRESS -- -- CITY, STATE,ZIP — -- RCONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE 1n I.S c - (k ijo-cV_ c-3co-�os�w c-- 5(e . .1,STREET ADDRESS CITY,STATE, ZIP - 1© ( 2g c C-,_ �fi) c f'\- 1 SAIL PHONE BUS.LIC K • C) Me Q .E,{ u. c„PetAf• e -, � � ,3 7--27` 7433 4 D S 3 }a . . 0 ARCHITECT••❑OWNER.0 OWNER AGENT�CONTR.ACTOR AGENT❑ENGINEER❑DEVELOPER 0 TENANT 1 C NTACT NAME f E-MAIL 6°E1' C,l Ili ( c ETA RESS CITY,STATE,ZIP PHONE fd on: I �� C- ik \ C aS1 40 . �3 41S._) DEC I �ac-�n1` . CA \--e Ir nl (P sS,0 („,Q j • I • ❑SINGLE-FAMILY/DUPLEX IDMULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE, EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQIFT. VALUATION(5) I REMODEL ' REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED BATHROOM SF SF SF SF . 0 DETACHED EXISISPRINKLERS 0 NO EICHLER O YES SECOND STORY ADDITION DYES FIRE0 NO DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER ' UNITS , 'UNITADbITON: 1:1 No SF • POOLS i, 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED ,POOL-SF�.' SPA-SF I SPA ATTACHED DYES 0 NO I TOTAL-SF EIVED BY: Naat.., .2,;:„,,_,..„.„.„.„.„ Convuerral or Milt Famihi Buildings'with Puhlir Seidmivinp Pools reanires Department ofEnviropmenhil Heath approval ti I 1* RE ROOF EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLESE WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE❑;NO. IF NO. PLYWOOD Ill 1/2" ❑3/8" ' 'PLYWOOD TYPE: FITCH: ROOF CLASS DYES g OF LAYERS THICKNESS❑5/8" OTHER ❑OSB E CDX OTHER .12 A PROPOSED',ROOF TYPE:DBUILT-UP ROOF'❑ASPHALT SHINGLES ❑WOOD SHAKES.❑WOOD SHINGLES 0 OTHER *Provide a signed cpv 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 conipl;y'with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter theiabove-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be Made available for public'reco .. �� J 2q—,//' // • Signatlsre of Applicant/Agent: � \ Date: _ _ SUPPLEMENTAL INFORMATION RIO- is ' *New SFD/Second'Dwelling Uriits/Muldfamily 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 df'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