B-2017-2095 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2095
10020 MOSSY OAK CT CUPERTINO,CA 95014-5615(342 32 103) PAULINO''S
CONSTRUCTION INC
SAN JOSE,CA 95121
OWNER'S NAME: TING'EDWARD C AND ALICE C DATE ISSUED: 12/07/2017
OWNER'S PHONE:408-863-3230 PHONE NO:(408)528-9209
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
License Class 13 Lic.#472192 •
Contractor PAULINO'S CONSTRUCTION INC Date 04/30/2019 X BLDG ELECT _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:
REPLACE RETROFIT WINDOWS(6);REPLACE RETROFIT SLIDEER
I hereby affirm under penalty of perjury one of the following two declarations: (1);LIKE FOR LIKE TO MEET EGRESS
t: 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.
, 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:$7500.00
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 342 32 103
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 .jed'f'vill comply with all non-point
source,regulations per the 4- unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
•ature / ate 12/7/2017 Issued by:Jasmine Archbold
Date: 12/07/2017
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 roofing material being installed.If a roof is
i` 1,"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 tb construct the project(Sec.7044,Business&Professions Code). Date:12/7/2017
i
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I 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
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino . `oipal i de,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S• ons 25 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. •r or authorized agen
'APPLICANT CERTIFICATION V'a•'te: 12/7/2017
I certify that I have read'this application and state that the above information is CONSTRU' ION 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, 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
'anti 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 12/7/2017 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
4a10300 TORRE O E AVENUE • CUPERTINO, CA 95014-3255
- i< 4,,t..r* (408) 777-3228 • buil dingGcupertino.org PEMIT«B- 1� •.
•
CUPERTINO REV# DEF#
' ❑ NEW CONSTRUCTION ❑ADDITION ®ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA•
PROJECT ADDRESS APN A
01-C2-? NA-0_5 5i a 6-K a-1-
OWNER NAME PHONE
CAW e."6" fi
�— I geil^ @ J 3 -3230 1E-MAIL
STREET ADDRESS! Z.Q CITY, STATE,ZIP
_- -ag im.o as/ 0a,k— - -- ._ --------
ryJ cONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSEyNUMBBEER LICENSE TYPE
, UN my ii ego sin tool I ell
ISTREET ADDRESS CITY,STATE, ZIP
270 q Les *Ms pe: .4i i ,a-� Cil E-MAIL PHONE BUS.LIC p T�l Z�
tS- ��6� 3� �� C/o3 --) ( 1
0 ARCHITECT'❑OWNER.0 OWNER AGENT IR CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAM E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
270 f. '•S 4'// 5 D' ' S3," .1dtc..- fr72-/ c/o$- 44- - 37eYY
DECRIPTONr
fee/714 cc 'CO' Rz- ti 4 i'Jaws-
i2 ?lac C' jZ z fin t•-I- 5%'L a4-4
❑SINGLE-FAMILY/DUPLEX ❑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)
1
REMODEL . REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑Y�
FIRESPRIN'KLERS 0 NO ; ❑ NO 0 NO .
DWELLING SECOND DWELLING 0 yEs 0 ATTACHED DETACHED OTHER
UNITSP Z UNITADDITON: ❑NO 5F
POOLS! 0 FIBERGLASS '12'VINYL-LINED 0 GUNITE 0 PREFABRICATED - •
POOL-SF SPA-SF ;I SPA ATTACHED❑YES 0 NO I TOTAL-SF
EY: 'TOTALUATION:
Commercial or Multi-Family Buildiues with Public Swimming Pools requires Devartment of Environmenwl Heath approval , 7 ov
/
RE-ROOF EXISTING ROOF TYPE:;❑BUILT-UP ROOF❑ASPHALT SHINGLES E WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO 'IF NO . PLYWOOD ❑1" ❑3/8" ' PLYWOOD TYPE: PITCH:• ROOF CLASS
!❑YES °OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX. OTHER •12 A
PROPOSED ROOF TYPE:❑Bt 11LT-UP.ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed,copy of the Cupertino's Tear-Off Policy SF rot 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 section p ':ores. acknowledge and authorize all information contained on this application form
to be made available foi-:public re , /Z/�J I
Signature of Applicant/Agent: Date: .
SUPPLEMENTAL INFORMAT0 1 REQU 1D
13
*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
BIdg,9pp_2017.doc revised 08.01/17