B-2017-2105 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2105
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: 12/08/2017
OWNER'S PHONE:408-913-0384 PHONE NO:(408)282-7025
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#939034
Contractor GOGO ROOTER Date 10/31/2019 X BLDG —ELECT X 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 Mem
license is in full force and effect. JOB DESCRIPTION: 5 .w v
PROPERTY LINE CLEAN OUT;REPLACE VER
I hereby'affirm under penalty of perjury.one of the following two declarations:
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
91•rformance of the work for which this permit is issued.
a• 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:$13000.00
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 a•. nst liabilities,judgments,costs„and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue again aid City in cons_•uence of the granting of this permit. WITHIN 180 DAYS OF PEIIIT ISSUANCE OR
Additionally,the-••licant and•rstam's and will comply with all non-point
source regulatio -per th• C,•erti • Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
iignatuire Ifs a ` Date 12/8/2017 Issued by:Abby Ayende
Date: 12/08/2017
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
1. 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)
z. I 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: 12/8/2017
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 equipm• t or devices which emit hazardous
air contaminants as defined by the Bay A •:Air Qua.ty.Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupe iryry. Munic',al Co,e,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,5: ti i ss 25505.25533,and 5534.
Labor Code,I must forthwith comply with such provisions or this permit shall
•be deemed revoked. caner -;f1/1M11116 A
or authorized agent.
APPLICANT CERTIFICATION Date: 12/8/2017 &i V Tr ,
I certify that I have read this application and state that the above information is IL T•. ��_ •►LEL i I► • E V
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is .r�onstruction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per J 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 12/8/2017 Professional
t, CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
4:r te" (408) 777-3228 • build.ingc(�Icupertino.org PEMIT#B- -° - �
CUPERTINO . REV# DEF4
' ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS SlC'N ��� � � APN A ��5
�
�e 0 3
OWNS NAME PHONE E-MAIL
(e litei/rr� r Ai 1 0 r t-C-— Eel, - ` 13-c'3(c-\-(i_ ,
STREET ADDRESS CITY, STATE,ZIP Y
64rin.n0.Y4— 4 1 E—V3[ e J Y•-el 0 in - `CV.OR NAME ❑ONER-BUILDER COMPANY NAME 7O1
LICENSE NUMBER LIE TYPE
, . eLo“) te‹).4kg- 95 70.?1 . (-- 3,6
EET ADDRESSC STATE, ZIP I
�jZ� p1'eiCAV �'`'e_ w So 3e CP
E-MAIL PHONE BUS.LIC.;
❑ARCHITECT 0 OWNER.❑OWNER AGENT NTRACTOR AGENT ENGINEER 0 DEVELOPER ❑TENANT
CONTACT NAME (�,_ (! E-MAIL
Vim" 616-9 t0) .
STREET ADDRESS STATE,ZIP PHONE
J26, " I /)(G- 'Y . \fes ' P^'I/.- SCfl2. c A -
- DECRIPTON
e1172(0—e-I j Main 5 < GI/le- 04.. d.(kL
•
r)roFec-4 e7ec u,.., - .
INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
XISTING USE. EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES F TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(S)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF. 0 DETACHED
EXISING ❑YES EICHLER 0 ES SECOND STORY ADDITION OYES
, FIRESPRINKLERS(Q NO p.NO ' J,NO -
DWELLING S COND DWELLING ❑YES 0 ATTACHED DETACHED OTHER '
UNITSI UNITADDRON: ❑NO 5F
POOLS 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED.❑YES 0 NO I TOTAL-SF
REC(/E��D T�TAIL VALUATION:,I
Commercial or Multi-Family Buildings with Public Swimmine Pools requires Department or Environmental Heath approval �t tli l 1J Gli 1 J
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) ,
REMOVE/REPLACE❑NO IF NO PLYWOOD 01"" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0 YES F OF LAYERS 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 Cupertino's Tear-Off Policy SF ;of SQUARES
By my signature below I certify to each of t e following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this application and the inform- ion I h---provide', is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordi'ances .'�: state la 's relating to building construction. I authorize representatives of Cupertino to
enter the above-identified propert, fo nspe, . purpose.. I c 'to,,ledge and authorize all information conta'Zed jii this application form
to be made available for public r: .1, 1' - 'I .Signature of Applicant/Agent: ' Date:
SUPP
LEMENTAL INFORMATI 9N EQUIRED------' ,
*New SFD/Second Dwelling Unit•/' ultifamily 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.
WHOA-Provide a letter of approval from the Home Owner's Association .
Bldg4pp_2017.doc revised 08/01/17 '