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B-2018-0088CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0088 21095 LAURETTA DR CUPERTINO, CA 95014-1655 (326 55 010) MIKE COUNSIL PLUMBING INC SAN JOSE, CA 95131 OWNER'S NAME: CARR CYNTHIA L TRUSTEE DATE ISSUED: 01/12/2018 OWNER'S PHONE: 408439-1842 PHONE NO: (408) 272.4900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic. #679261 Contractor MIKE COUNSIL PLUMBING INC Date 04/30/2019 X BLDG —ELECT x PLUMB MECH $ RESIDENTIAL _ COMMERCIAL 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. JOB DESCRIPTION: REPLACE DRAIN LINE (PVC) - UNDER KITCHEN 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 performance of the work for which this permit is issued. z. 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: $5334.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 55 010 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 and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 01/12/2018 Issued bv: Jasmine Archbold OWNER -BUILDER DECLARATION Date: 01/12/2018 I hereby affirm that I ant 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. 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 to construct the project (Sec.7044, Business & Professions Code). Date: 01/12/2018 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. 1 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 equipment or devices which emit hazardous 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 Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, ections 255 5, 25533, and 25534. Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 01/12/2018 I certify that I have read this application and state that the above information is CONSTRUCTION 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, 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. 1 understand my plans shall be used as public records. ;Licensed Signature Date 01/12/2018 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building@cupertino.org PEMIT B CUPERTINO REV# DEF9 I—I NEW CONSTRUCTION I—I ADDITION n ALTERATION I—I T T n MEP n RE -ROOF n SWIIvII 4ING POOL/SPA PROJECT ADDRESS Z l / M oq5r L 1(J 1 MIN t �� t O OWNER NAME P NE E-MAIL C��d a - STREET ADDRESS 2-16 1 a.u�' t r CITY STATE, ZIP �(`�," CSI- a S014y CONTRACTOR NAME ❑ OWNER -BUILDER MPANY NAME LICENSE NU\SER LICENSE TYPE lC,s �ikv_ Co, -"4 ��b, C3� G 7 ?4.1 w STREETA KESS w�. CITY, STATE ZIP Lql do �. 14 E-MAILPJiONE BUS. LIC t cuo 37 ❑ ARCHITECT ❑ OWNER OWNER AGENT ❑ CONTRACTOR AGENT E3 ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTON ,�..� 1 C -Q-h dfyLin C.i o -Q, I Gs -Q- w� v,y G SINGLE-FAMILY/DUPLEX [I MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC Sur. VALUATION (S) EXISTING USE EXISTING SF NEW FLOOR SF I PORCH SF I DECK SF I DEMO SF I STORIES t I TOTAL NET SF REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED EXLSING ❑YES FIRE SPRINKLERS C] NO EICHLER 11 YES ❑ NO SECOND STORY ADDITION � YES DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER UNITS t UNIT ADDITON: ❑ NO S F POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA - SF I SPA ATTACHED 0 YES ❑ NO I TOTAL - SF Commercial or Multi -Family Buildin es a+ifh Public Sminnning Pods requires Dennrtmen! o(Enairmunerifnl Heath rtnvrn.+al EIVED BY: 17�V7TALLUATION': ��) p `( RE -ROOF EMSTLNG ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGL ❑ TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO IF NO PLYWOOD ❑'h" ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑ YES t OF LAYERS I THICKNESS ❑ 5/8" OTHER []OSB ❑ CDX OTHER :12 A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD 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 an state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property fo inspection urposes. I acknowledge and authorize all information contained on this application form to be made available for public rec1r' Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION WEQUIRED *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