B-2017-2034 • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2034
10620 S DE ANZA BLVD CUPERTINO,CA'95014-4450(369 38 039) METRO MECHANICAL
INC
SAN JOSE,CA 95136
OWNER'S NAME: BYER PROPERTIES LP DATE ISSUED: 11/28/2017
OWNER'S PHONE:408-227-7276 PHONE NO:(408)227-7274
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#825697
Contractor METRO MECHANICAL INC Date 10/31/2019 X BLDG _ELECT _PLUMB
X MECH_RESIDENTIAL X 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:
DE ANZA CENTER-T.I;REPLACE(10)AC UNITS(LIKE FOR LIKE)
I hereby affirm under penalty of perjury one of the following two declarations:
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
rformance of the work for which this permit is issued.
..Dave and will maintain Worker's Compensation Insurance,as provided for by
-ection 3700 of the Labor Code,for the performance of the work for which this •
permit is issued. Sq.Ft Floor Area: Valuation:$78000.00
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 38 039
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 a Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
•gb
•E2 ature Date 11/28/2017 Issued by:Abby Ayende
Date: 11/28/2017
OWNS LDER 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
i. 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: 11/28/2017
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 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 Califomia. If,after making this certificate of will maintain compliance with the Cup, tiney unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,! tion/5505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
,i _ or authorized agent: Y.
APPLICANT CERTIFICATION I ate: 11/28/2017
I certify that I have read this application and state that the above information is .T'.t IL L ►D • EN V
correct.I agree to comply with all city and county ordinances and state laws .1 I hereby affirm that there is Mrstruction 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.
Signature Date 11/28/2017 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION - B
10300 TORRE AVENUE • CUPERTINO CA 95014-3255
?,`'' '' (408) 777-3228 • building@cupertino.org PEMIT#B- 1�- - Z094
CUPERTINO AMER DEFE ►►
❑ NEW CONSTRUCTION ❑ADDITIONI� ❑ALTERATION ❑T.1. J/� ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT(6 DRES5(/V II A717,10, 4 A 10ei r APN6R` 3`✓ et - 5 -- d 9
OWNER NAMENev, 1 c- PHONEPHONE , 27,1'`��Y'E-MAIL
STREET ADDRESS x'11 CITY, STATE,ZIP {)
CONTRACTOR NAME ❑(OWNER-BUILDER/�COMPANY NAME LICENSES NUMBERLICENSE TYPE
STREET ADDRESS P C ATE, ZIP
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E-MAIL PHONE tf('V ^�...-7 (9 J BUS.LIC✓t
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0 ARCHITECT ❑OWNER ❑OWNER AGENT NTRACTOR AGENT ENGINEER❑DEVELOPER❑TENANT
CONT CT'NAME E-M IL
is m i:r cg',rn c0a wv_f r, Ivl L cJ,'h mice U -t-
STREET ADDRESS CITY STATE, IP PHONE
2)-i c -fir- f at, ( -je Se , CA- 95(3L, 1(08 PP-7-72'
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tpkG-C.�,A'1C) r' Ac�Li-Ale__'� `1'16.*)�, 0.: �}, -LI Wy r-!A(-' h-t Et.." i�'1 l.e
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)—®C e�e,Ii-f,`� S'-e Foot p�^oJ..ec ( 1 .
•
❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO5 STO ESA TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(S)
REMODEL REMODEL KITCHEN. REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF j SF SF 0 DETACHED
0
EX
FIRE IING YES SPRINKLERS ID NO EICHLER 0 NO O I SECOND STORY ADDITION ❑❑YES
NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER
UNITS A UNIT ADDITON: ' ❑NO 5 F
POOLS 0 FIBERGLASS 0 VINYL-LINED:❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED(]YES 0 NO I TOTAL-SF
RE �(D�BY: I r tifW f 15-0,, 51,11,,
Commercial or Multi-Fonilu Buildings with Public Swimming Pools requires Department of Environmental Heath approval jet Lkkikk
„, 44 I.
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES I=1 WOOD SHI,NGL ❑TILEOTHER(SPECIFY)•
4
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑m�„ ❑3/8” PLYWOOD TYPE: PITCH: ROOF CLASS
DYES A OF LAYERS 1 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 Cupertirio's Tear-Off Policy SF :of SQUARES
By my signature below I certify to eachof 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 andverify 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 property for inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public reir•,
Signature of Applicant/Agent: ` r c..,..„/„......), Date: GraY/'- /3- /—7
SUPPLEMENTAL INFORMATIOEQUIRED ,
*New SFD/Second Dwelling Units ' ltifamily Dwellings:A Demolition permit is required prior.to issuance of a building permit forall 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 .
1& n 1(a {
BldgApp_20/7.doc revised 08/01/17