B-2017-2086 •
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: . PERMIT NO:B-2017-2086
18831 BARNHART AVE CUPERTINO,CA 95014-3601(375 16 053) GOGO ROOTER
SAN JOSE,CA 95112
OWNER'S NAME: MARTINEZ HENRIETTA B AND RICHARD D TRUSTEE DATE ISSUED: 12/06/2017
OWNER'S PHONE:408-893-2934 PHONE NO:(408)282-7025
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LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT •
INFO:
License Class C36 Lic.#939034
Contractor GOGO ROOTER Date 10/31/2019 X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with'Section:7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. • JOB DESCRIPTION:
CLEAN-OUT-ADD CLEAN OUT ON MASTER BATHROOM(SIDE OF
1 hereby affirm under penalty of perjury one of the following two declarations: 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
.erformahce of the work for which this permit is issued. •
e 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:$2340.00,
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 16 053
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. :inst liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agar said city in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the .+Iia,` understan s a i will comply with all non-point
source regulati. ,pe- - Cupe i . M/ipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
YI Date 12/6/2017 Issued by:Jasmine,Archbold
Date: 12/06/2017
I hereby affirm that I ani exempt from the Contractor's License Law for one of the RE-ROOFS:
fotloving'two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
:j. 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)
• z. 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: 12/6/2017
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 2553 ia)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 ipment or devices which emit hazardous
air contaminants as defined by the :a Area• Quality Ma,a emen I istrict I
Worker's Compensation laws of Califomia. If,after making this certificate of will maintain compliance with the u I ertin unicipal Co.e, hap..r 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co,e,`ectio 5505,
Labor Code,I must forthwith comply with sucli provisions or this permit shall
be deemed revoked. a authorized agent.. .
APPLICANT CERTIFICATION f�a :12/6/2017 vr
I certify that I have read this application and state that the above information is I►_ R TIS L LE►DI.G• _ ► Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per it 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 12/6/2017 Professional
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONB -
, „; 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
�zaD (408) 777-3228 • rui]ding@cupertino.org PEMIT rB- n l 1 - _7 o8 ,
CUPERTINO REV; DEF;
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❑ NEW CONSTRUCTION ❑ADDITION'❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMA'fING POOL/SPA
PROJECT ADDRESS /s8.3( i 1� (- APN 37
5 - I,C _b tD
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OWNER NAME jZ(c 1-C&f0f r May �-I z PHONE IP ,/' �h�I -MAIL _
STREET ADDRESS /1{—���"13 l b AVL CITY, STATE,ZIP '16 �Ij x'17 t
yCONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER :LICENSE TYPE
I
STREET ADDRESS 24 P1���,,� A C ��STATE, ZI�,:s • C ,^
E-MAIL PHONE BUS.LIC p
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rLLL6 OES-G
❑',ARCHITECT ❑OWNER.0 OWNER AGENT 12CONTRACTOR AGENT 0 ENGINEER 12DEVELOPER 0 TENANT
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CONTACT NAME /J (71C) n ((€1,10)E-MAIL .
STREET RESS6:, (7LL Q- 1 w CI Ix,S.44".TATE, A a 5 C46-
^ q+,�Z (t '�J 24 Z
' DECRIPTON �' "` �f3J Y+ I i
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SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODEL OTHR ' GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISi5 SPRINKLERS 0 NO EICHLER 0 NO ES SECOND STORY ADDITION O
YES
FIRENO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER
UNITS+ UNITADDTTON: 12 NO SF
POOLS ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
' 1 ,,.‘„js.. ........_.
POOL-SF SPA-SF I SPA ATTACHED 0 YES 0 NO I TOTAL-SF law`R LEIVED BY: ✓7AL ION:
Commercial or Milli-Familu Buildhs1s with Publir Swimming Pools resuires Devm9ment o(Enviroamevtal Heath mama;
RE-RD OFI EXISTING ROOF TYPE: Ei BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIF1)�J
REMOVE/REPLACE Q NO IF NO - PLYWOOD ❑'A"" ❑3/6" ' PLYWOOD TYPE: PITCH: ROOF CLASS
0 YES I F OF LAYERS THICKNESS❑5/8" OTHER' 005B 0 CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 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 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 or. anc- and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property fonsp on purposes ac wledge and authorize all information contained on this application form
to be made available for public recor. _/
Signature of Applicant/Agent: R/ e m:tr-__. 1Q
SUPPLEMENTAL INB EIC n '4'IQ UIRED '
*New SFD/Second Dwelling Units tifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a ,o plated Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter Meeting With Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
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BJdg.4pp_2017.doc revised 08/01/17