B-2018-0040CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0040
10745 S DE ANZA BLVD CUPERTINO, CA 95014-4462 (359 23 017) BAY QUALITY
CONSTRUCTION INC
FREEDOM, CA 95019
OWNER'S NAME: MARMON BRIAN F TRUSTEE & ET AL
OWNER'S PHONE: 831-425-4519
LICENSED CONTRACTOR'S DECLARATION
License Class f,,U Lic. #962441
Contractor BAY QUALITY CONSTRUCTION INC Date 07/31/2018
I hereby affirm that 1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
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
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
S1. Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
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
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
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I hereby affirm that I ant exempt from the Contractor's License Law for one of the
following two reasons:
1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Scc.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
t. 1 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.
2. 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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Date 1/5/2018
DATE ISSUED: 01/05/2018
PHONE NO: (831) 722-2298
BUILDING PERMIT INFO:
X. BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
REROOF; CEARAMAFLEX FLUID APPLIED ROOFING AND
WATERPROOFING (34 SQ)
Sq. Ft Floor Area: J Valuation: $6000.00
APN Number: Occupancy Type:
359 23 017
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Avende
Date: 01/05/2018
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ofApplicant:_I �.,.
Date: 1/5/2018
IIA„
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should 1 use equipment or devices which emit hazardous
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
the Health & Safety Code, Sections 255F.25533, and 25534.
Owner or authorized agent: '
Date: 1/5/2018
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
a] 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 a building@cup%J(ertino.org PEMIT #B - G� v" `0
CUPERTINO REV # DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
I
APN
10745 S. De Anza Boulevard
J�,
OWNER NAME PHONE
E-MAIL
Brian Maridon 831-425-4549
maridon@cruzio.com
STREET ADDRESS CITY, STATE, ZIP
118 Union Street Santa Cruz, CA 95060
® CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
Farbod Dinyari Bay
Quality Construction
1962441 �B,
C33, C39
STREET ADDRESS
CITY, STATE, ZIP
399 Airport Boulevard
Freedom, CA 95019
E-MAIL
PHONE BUS. LIC #
fvaldivia@bayqualityroofing.com
831-722-2298 1 36400
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT M CONTRACTOR AGENT 13 ENGINEER ❑ DEVELOPER ❑ TENA,\
CONTACT NAME
Farbod Dinyari
E-MAIL
fvaldivia@bayqualityroofing.com
STREET ADDRESS
CITY, STATE, ZIP
PHONE
399 Airport Boulevard
Freedom, CA 95019
1408-759-1303
DESCRIPTON
CeramaFlex Fluid Applied Roofing System and Waterproofing of Penetrations.
❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL M COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
I PORCH SF
DECK SF
I DEMO
SF I STORIES t
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
EXLSING ❑ YES
FIRE SPRINKLERS [3 NO
EICHLER ❑ YES
13 No T❑
SECOND STORY ADDITION ❑ YES
NO
DWELLING
SECONDDWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF I SPA ATTACHED YES NO TOTAL - SF
RE EIVED
BY:
TOTAL VALUATION:
Commercial or Multi Buildings with Public Swimming Pools requires Department of Environmental Heath appmaal
(�_
$6,000
RE-ROOF
EXISTING ROOF TYPE: [] BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑
WOOD SHIN ES TkLE OTHER (SPECIFY)
REMOVE /REPLACE ® NO
YES
IF NO
# OF LAYERS 1
PLYWOOD 0 "" ❑ 3/8" PLYWOOD
THICKNESS Q 5/8" OTHER
TYPE:
❑ OSB ❑ CDX OTHER
PITCH:
' 12
ROOF CLASS
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF DASPHALT SHINGLES iO WOOD SHAKES ❑WOOD SHINGLES 13 OTHER Fluid
*Provide a signed copy of the Cupertino's Tear -Off Policy SF 3400 #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 inspection pur es. I ac wle a and authorize all information contained on this application form
to be made available for public recor 1-5—
^5— I do
Signature of Applicant/Agent: Date:
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 08101117