Loading...
B-2017-1588 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1588 22100 STEVENS CREEK BLVD CUPERTINO,CA 95014-1094(357 10 007) D C CONSTRUCTION LOS GATOS,CA 95033 OWNER'S NAME: CUPERTINO CITY OF DATE ISSUED:12/05/2017 OWNER'S PHONE:408-777-3200 PHONE NO:(408)499-8636 LICENSED CONTRACTOR'S DECLARATION. BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#789763 Contractor D C CONSTRUCTION Date 01/31/2019 X BLDG _ELECT _PLUMB 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: BLACKBERRY FARMS GOLF COURSE-CONSTRUCT(N)SHED(320 I hereby affirm under penalty of perjury one of the following two declarations: S.F.)TO BE PLACED 11.5-FEET FROM PROPERTY LINE. 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 erformance of the work for which this permit is issued. 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 _paint is issued. Sq.Ft Floor Area: Valuation:$7400.00 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 357 10 007 A(Tenant Improvements) 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,th- -.plicant understands and will comply with all non-point source regula . •er the unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature AIN Date 12/5/2017 Issued by:AbbyAyende `I Date: 12/05/2017 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 roofmg 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 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:12/5/2017 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 1 .evices . itch emit hazardous air contaminants as defined by the Bay Are: •t Quality M,,agement District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the • +.o Municipal Co.•,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ,:25505,25533 and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall -- be deemed revoked. ���I� ner or authorized agent: I APPLICANT CERTIFICATION OF Date:12/5/2017 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 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 12/5/2017 Professional . 3-7.014- isn CONSTRUCTION PERMIT APPLICATION f COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,f " 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 'r ' CUPRTI NO (408)777-3228 • FAX(408)777-3333•tuildinq(ccupertino,or�c NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT 4 ,� PROJECT ADDRESS /) ` S 1'•e..V�n q .C. <5(v4 APN ti 3--54 s -• `Q -.CD:- -- . ./�'• - OWNER NAME h } p `/ PHONE ' 1 E-MAIL`'v_l Ci1� a k---Uy T1Y•IC'G I 4/A9—)77-320 STREET.4DDRESSCITY, STATE,ZIP ^ � ( FAX 1L5 3jo rre, L �� Cupp}f�Q., CONTACT NAMEPHONE .E-MAIL`T'i °i1,u � S l � COCo� `� '777 1' ZS iia-►. C. C()peel.,n0.. g. STREET ADDRESSCITY,STATE,ZIP 7 FAX _._ 22,1C0 S+evcn5 Creek _V1va coper' 'in a CA - — — ❑ OWNER 0 OWNER-BUILDER IpI,.OWNERAGENT 0 CONTRACTOR ❑CONTRACTORAGENT 0 ARCHITECTe0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME•�kAvi� ��fv�}���,r^ -�_ LICENSE NUMBER 72 ` I LICENSE TYPE a BUS.LIC 10"Z [/ '�a COMPANY NAME �C C 1Y t 4na,rQ`I E-MAIL pc...R. �7 r\�� l�(� FAX I J ( STREET ADDRESS ([i}-.i fe.. ' rjf1 ?)rltie, CITY,STATE,ZIP fr�iS &la 42.3 ,?5-493•+ PH ON Lf�}2,e q. 163 ARCHITECT/ENGINEIIR NAME•'f y/ �f V LICENSE NUMBER ` • BUS.LTC[fl c' COMPANY NAME E-MAIL FAX STREET ADDRESS ---� ------- CITY,STATE,ZIP `.-_.-.._ 2._:,/,C1 c c PHONE .--_-- DESCRIPTION OF WORK �e. Q l 1 1°'n Q 1 ,_ J h ed / g M j 5'e-rv1«. 00,-,5-1-(-00-,q,, 4n-et.� C•e. en-4 3l& 4 C.On 3 4 r ucA'ta,, of _— ---. \k L4 7.vitihed C..colo, _ o _ l�-Ccv.,17ecc•l.-r, Z-� ricc- Sub -- ai•e. Nett C-i %5 EXISTING USE PROPOSED USE CONSTR.TYPE *STORIES USE TYPE] OCC. 1 SQ.FC. VALUATION(S) EXISTO NEW FLOOR DEMO TOTAL T®_ AREA AREA AREA NET AREA BATHROOM KIPCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK!PORCH AREA GARAGE AREA: DETACH -___ ATTACH 4DWELLING UNITS: ISA SECOND MIT ❑YES SECOND STORY ❑YES ---"-- BELRGADDED? LINO ADDITION? 0N • • PRE-APPLICATION DYES IFYES,PROVIDE COPY OP ISTHEBLDGAN ❑5'ES isj C-1,V.DTi]",n;` '`_I` `''t'i>��'�-`.,T,c� "�r;?F�� TOTAL VALUATION; • PLANNING APPLP'-❑NO PLANNING.APPROVAL LETTER EICHLERHOME? 0N •'I'�.'ti� 'it .:-.T',...1,1.I re ''• v.'-n -5 1401) • • By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on e property owners behalf. I have read this application and the information I have provided is•correct, I have read the Description of\Vork and verify it is accurate, I agree to comply with all applicable local ordinances and state laws relating to building co ctio I autho ' • e•tiv- Ciii>etino to enter the abov identtii5ed property for inspection purposes. 1 Signature of Applicant/Agent:- .-• �/I �GY Date: '�/ r 77 . SUPPLEMENTAL INFORI\ • ION REQUIRED u "'#""r llral� ECC >•l e ? "gib' gt -� •Y,.i<: . Q ��1r'�Iw... ..,..,, ••ECf{;T.i' -.iy+: uy,...iii S RU(JTT!�G•SLIP,> 'y'?a ' SiU ."�t'�Cfin."iCS..`itl)?.S ^���::'s'-°ytiL'.. _I!. Y.:1» .',•'?.T..SS.['y._1VFy.1�i:::�r:Yi�t.::�i:..'7.:';_�_ _New SFD or Multifamily,dwellings: Apply for demolition permit for iii]±ovh._f • 6L1TEli$:;i�'�; ;. ':diol dl ti'EA, izEi'iE 'i�'''�:`}1'i' existingbuildin s. Demolition permit is required prior to issuance ofd' r r`:'�a:,.->1,,1.;,,'.p::^rt :ii$1>: .o,.,t•".I,'�;:-,. ; :'_:=_•-;_�.•�.,:-�c'::r>': ,>` '°:... g� ) I 9 p Ibull mg �:"�},'���,•�15�. ��zRr;< � N�dC �s 8}y t � r .... �'"'�a9•L�',dnhkCl a,.r- Ji,I } Ir ", $".'c 1�� 4h,,`”7:?, permit for new building. ;0,'\PRESS ^ F'iW„r , il L�)'PLAN'\ING PLAT RE\ZE\Y g. igip, '�t4,,• at 4 "� 1 -- A...:`''r'.o'o_gid e, v.1-ANY . l .i : Commercial Bldgs: Provide a completed Hazardous Materials Disclostn.e :. STAh�`D4Rn ` ❑fiPUBLIC:\FORKS•..g,;�r,. ; form if anyHazardous Materials are beingused as part of this project. -'�-r_ =- nii��-���=;::;��• .-.:.!. ;. �'.Z;Ak�E�:r-_ ',.;I��y;:::��;` - 'I'�'.1'hF DEI'T"v;:;=sF:"'.,c,-,�:i-�S :; .'h. yfr "n'_ Ej'; ',''-'s Py; T 7:' ' `'err 'Is::::_<t5;'-.a'� Copy of Planning Approval Letter or Meetingwith Planningpriort s ,, ;;p '- .�, :,+.-sEx,plkzi ' ��.�.-.1g--J __ v Q,, 'L4JOI24 2.,.� ?eY"; '-7:i.m ,•:l:.."©3lSmiITARY:S$�,p17:p.ig c."'', `, submittal of Building Penult application. .-. ,,;?- .ter.�..:,,,,,,,'.•,. ,.F' i ,�,,.-.. 3. V ,v4 L .i-.,:«15 -3 g,:n.R..4.r'3 x .st..ali3,-!In-En'11IRdT`A•ItNekLHfiAL H: ',f; BldgApp_2011.doc revised 06/21/11