B-2011-0973 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-0973
10314 MIRA VISTA RD CUPERTINO,CA 95014-2745(357 02 022) MAINE ELECTRIC INC
LIVERMORE,CA 94551
OWNER'S NAME:SUMNER ROBERT BOWATER TRUSTEE DATE ISSUED:06/07/2018
OWNER'S PHONE:408-656-3077 PHONE No;(925)443-3377
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ELECTRICAL Lic.#830250 X BLDG X ELECT_PLUMB
Contractor MAINE ELECTRIC INC Date 04/3012019 —
I hereby affirm that I am licensed under the provisions ofChapter 9(commencing _MECH x RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
INSTALL DEDICATED CIRCUITS(3);OUTLETS(2);REWIRE
I hereby affirm under penalty of perjury one of the following two declarations: OUTLETS(7)
r. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 o£the Labor Code,for the
performance 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: Valmrtion$6877.10'
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 35702 022
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 Cu ertino Municipal Cade,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/07/2018 Issued by:Kim Dunbar
Date:06/07/2018
O Eli-B DER DECLARATION
I herebyyrr fRrm that I am exempt from the Contractor's License Low for one of the RE-ROOFS:
folk6l g two reasons: All root's shall be inspected prior to any roofing material being installed.If a.of is
1. 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(See.7044,Business&Professions Code)
z.
1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date.06/07/2018
1 hereby affirm under penalty of perjury one a]the following three declarations: ALL 1200F COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation hrsone—,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
s. I certify that it,the performauce afthe work for which this permit is issued,I Health&Safety Code,Section 25532(x)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 o dIM•es which emit hazardous
air contaminants as defined by the Bay Aron r Qua ty Management District I
Worker's Compensation laws of California.If,after making this certificate of wIli maintain eomplinnce with th pe o-Myn'• at Code,Chapter 9,12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&S Cod a ons 2550,255 "55`34.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or author ed agent
APPLICANT CERTIFICATION Data:06 0
I certify that I have read this application and state that the above information Is - G AGEN V
correct.I agree to comply with all city and county ordinances and stale laws I hereby affirm that there ig- ons ruction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this 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. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 06/07/2018
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• building@cupertino.org PEMIT#B-1,0 61
CUPERTINO REV# DEF#_
[:1 NEW CONSTRUCTION ❑ADDITION E]ALTERATION 9T.I. +may�//n MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS r APN N -351 0-L
OWNER NAME I PHONE E-MAIL
zl��� �SG�'30?7
STREETADDRESS CITY,STATE,ZIP
s,P 0 cA 9.50/
❑CONTRACTOR NAME ❑OWNER-BUILDER [OMPANYNAME LICENSE NUMBER LICENSE TYPE
3:e :C `$ 2s-0 b
STREET ADDRESS I CITY,STATE,ZIP
5 s S}
E-MAIL PHONE BUS.LIC N
",� 9zs� 4, 3 -3377
❑ARC TECT
El OWNER❑OWNERAGENT❑CONTRACTORAGENT❑ENGINEER❑DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS C[TY,STATE,ZIP C/y f 1—F PHONE
S u. ee c/' cE °i2S� Y!1
DESCRIPTON
rXISH
NGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL
NG USE QXISTING SFNEW FLOOR SF PORCH SF I DQCK SP DEMO SF STORMS TOTAL NQT SP
USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OT[Ri GARAGE E]ATTACHED
BATHROOM SF ISE SN SF ❑DETACHED
EXISING El YES EICHLER []YESSECONDSTORYADDITION ❑YEs
FIRESPRINKLERS El NO 11.0
❑NO
DWELLING SECONDDWELLING E]YRS Q ATTACHED(]DETACHED OTHER
UNITS N UNIT ADDITOM ONO S F
POOLS ❑FIBERGLASS ❑VINYL LINED❑GUNITE []PREFABRICATED
POOL-SN SPA-sr, I SPA ATTACHED AYES ❑NO TOTAli`SP
RECEN Y: TOT EVALUATION:
G,1m,clniar MvIti-Fnnlih,BnildmV with Pub/icS.ffiniigPoals t'eg rhea Deyn 7n ontof El v'r rentpMmhn,m [ � ^'7 to
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOA❑ASPHALTSHINGLES❑WOOD SHAKES SHINGLES❑TILE rt
EXISTING !
REMOVE/REPLACE❑NO I IF NO PLYWOOD ❑h ❑3/8" PLYWOOD TYPE: P1TCH: ROOF CLASS
EYES #OPI•AYERS THICKNESS❑5/8" OTHER ❑OSB ]COX OTHER '12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF❑ASPHALT SHINGLES El WOOD SHAKES OWOOD SHINGLES❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF pof 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 owners behalf.I
have read this application and the information I have providyo is correct.I have read the Description of Work and verify it is accurate.I agree
to comply with all applicable local ordin es d stat a s relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property inspe 'o -] os S. dge-andauihorize all information contained on this application form
to be made available for public re rd. -7 '�iJ
Signature of Applicant/Agent: Date: JV ( vc(�
SUPPLEMENTAL INFORMA D
New SFD/Second Dwelling nits tiEamily Demolition permit is required prior to issuance of a building permit for all new construction.
"Commercial Buildings:P vide completed I-Iazardous Materials Disclosure form if any Hazardous Materials are being used as pail of this project.
"Copy of Planning Appr al Her or Meeting with Planning prior to submittal of Building Permit application.
.
HOA-Provide a letter .pproval from the Home Owner's Association
BldgApp 2017.doc revised 08101117