B-2017-2076 CITY OF CUPERTINO BUILDING PERMIT .
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2076
10385 MARY AVE UNIT 10385 CUPERTINO,CA 95014-1342(326,52 035) A R S AMERICAN
RESIDENTIAL
_ SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120 .
OWNER'S NAME: HAMMER PHILIPP TRUSTEE&ET AL DATE ISSUED: 12/05/2017
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OWNER'S PHONE:48-210-2357 PHONE NO:(408)283-9536
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#742039
Contractor R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG _ELECT•_PLUMB •
Date 10/31/2019 X 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 FURNACE AND AC UNIT-SAME LOCATION
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
Compenation,as provided for by Section 3700 of the Labor Code,for the
erformance 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 Sq.Ft Floor Area: Valuation:$10678.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is lcorrect.I agree to comply with'all city and county ordinances 326 52 035
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 applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
. source regulations per the Cupertino Municipal Code,Section 9.18. .
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Issued by:,Abby Ayende
S' ure .�, o rip) Date 12/5/2017 Date: 12/05/2017
I:
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm.that I am 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 do the 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:12/5/2017
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
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 . 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
3. I1 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
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
' :Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,2 533,a'. 25534. '
exemption,I become;subject to the Worker's Compensation provisions of the e 1
Labor Code,I must forthwith comply with such provisions or this permit shall ,
ner or authorized agent: aQAe— I�
be deemed revoked. ate:12/12/5/2017 /
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction 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 issued(Sec.3097,Civ C.)
relating to,building construction,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,costs,and expenses which may accrue against said City in
consequence of the 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.
Licensed
CONSTRUCTION PERMIT APPLICATION
X / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
r, s �"`..`C 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
at (408) 777-3228'0 bui]dingCcuuertino.or� PEMIT rB-7-0 U)- - 2'0
CUPERTINO • , REV# . DEFE
.
• ❑ NEW CONSTRUCTION ❑ADDITION dALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIlviMING POOL/SPA
PROJECT ADDRESS APN 8
. .: I03 TS M4tI
OWNER NAME PHONE
S _ ZIP-2351 E-MAIL
' �h r.• lawiwier' • •
STREET ADDRESS CITY, STATE,ZIP
103$5 /rias. :an , `i-50.1- ±
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❑CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
ARS Plvn,15;v8}H ecd. lit zo 3 ci C-2.0
ISTREET ADDRESS CITY,STATI1 ZIP
2.30S Po oov1 SCV4 -oae, Ch, • 9513t
E-MAIL PHONE BUS.LIC 8
.ivefte ckts• cowl , '4C • Z IZ,- 1156
0 ARCHITECT 0 OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
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STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON 1
Cto i3 604 CS 2.5 44"4 QOlt Veld , vas - C,Se_er. IS)CAcVE SO elo)
At- &Ak4' CuvN,LL iheikciumeiftA— . •
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SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES 8 TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(S)
REMODEL REMODEL KITCHEN REMODELOTHR ' GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING DYES EICHLER 0 YES SECOND STORY ADDITION ❑❑ ES
FIRE SPRINKLERS 0 NO 0 NO •
DWELLING SECOND DWELLING ❑YES ❑,ATTACHED❑DETACHED OTHER , '
UNITS 8 UNIT ADDITON: 0 NO S F
POOLS ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE' ❑PREFABRICATED
POOL-SF SPA-SF I- SPA ATTACHED❑YES 0 NO I TOTAL-SF
RECEIVED BY: ^ iT VALUATION:
Cnnmiereiul or Multi-FmnilV Bni(divvgs with Public Svinunine Pools rerwircs Demu9nient of&roapprovalvvenlal Heolh anvral (labbV\ �t";vell I I0 tm,.00
RE-ROOF EXISTING ROOF TYPE: E BUILT-UP ROOF Q ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHIN �LES-Q TILE OTHER(SPECIFY)
REMOVE/REPLACE Q NO IF NO PLYWOOD 01/2" ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS '
EYE B OF LAYERS THICKNESS❑5/8" OTHER ❑05B ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES OWOOD SHINGLES ❑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 ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
• enter the above-identified property for ins e t' n pure. . I a knowledge and authorize all information contained on this application form
• to be made available forl?ublic recor . 41111.►
I IS I
Signature of Applicant/Agent: — I ., - Date: !6�
SUPPLEMENTAL INFORMATION REQUIRED
*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%01/17