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B-2018.0919 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0919 10440 CORTE DE SEVILLE CUPERTINO,CA 95014-3407(375 05 016) CALIFORNIA PO WER AND LIGHT SAN MARTIN,CA 95046 OWNER'SNAME:O'KEEFE GERALD T AND FAY M TRUSTEE DATE ISSUED:05/29/2018 OWNER'S PHONE:408-202-1773 PHONE NO:(409)406-5832 LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO: License Class C1Q Lic.#7 068 Contractor CALIFORNIA POWER AND LIGHT Date 04/30/2020 X BLDG X ELECT_PLUMB I herebyaffirm that 1 am licensed tinder the f Chapter 9 in —MECH X RESIDENTIAL_COMMERCIAL a provisions o p (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. SOB DESCRIPTION: PANEL UPGRADE(200 AMP)SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 have and will maintain a certificate of consent to self-insure for Worker's C mpensalmn,as provided for by Section 3700 of 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 fmby Section 3700 of the Labor Code,for the peri'ormatiee if the work for which this permit is issued. Sq.Ft Floor Are.,: Valuation:$3500.00 APPLICANT CERTIFICATION I certify that I have read this application and stale that the above — information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy'fype; and state laws relating to building construction,and hereby authorize 37505 016 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 M ie pal dde,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 05-29-2018 Issued by:Kim Dunbar Date:05/29/2018 OWNER-BUILDS ECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law forces of the RE-ROOFS: following two reasons: All root's shall be inspected prior to any roofing material being installed.H a roof is I 1,as owner of the property,or my employees with wages as their sole installed without first obtaining en inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended at offered for inspection, sale(Sec.7044,Business&Professions Code) z. I,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicant eontraclors to construct the project(Sea 7044,Business&Professions Code). Date:05-29-2018 1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 have and will maintain a Certificate of Conseut to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,to the performanceofthe work for which this rot mil is issued, HAZARDOUS MATERIALS DISCLOSURE z. I have and will monanin Worker's Compensation Insurance,as provided for by I have read the bozordous materials requirements ander 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,still 25534.1 will permit is issued. maintain compliance with the Capin firm Municipal Cade,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Seaton 25532(x)should I store or handle hazardous shall not em to in an to become subject to the aaterial.Additionally,should I use equipment or devices which emit hazardous ampley mry person y manner so as J r onnitaminads as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California.If,after making this cellulosic of will aalntain 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,Sections 25505,25533,al Labor Code,I must forthwith comply with such provisions or this permit shalt be deemed revoked. Owner or authorized agent• APPLICANT CERTIFICATION Date:05-29-2018 I certify that I have read this application and state that the above information is CONSTRUCTI E ING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is ago struction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this pe/mitis 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 05-29-2018 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ��,�� (408)777-3228• buildirig@cupertino.org, PEMIT kB-2-S— CUPERTINO 1A � REV# DEF# [:]NEW CONSTRUCTION ❑ADDITION ❑ALTERATION❑T.I. �1 MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS QAPN k ' S tWO V�jle OWNERNAME PHONP6 E6�c./� E-MAIL STREET ADDRESS vaUd CITY,STATE,ZIP ONTRACTORNAME ❑OWNB-BUILDER COMPANY NAME { LICENSENUMBER LICENSE TYPE STREET ADD SSCITY TATE,ZIP q0 C +EMAIL BUS. 3 ❑ARC/II11r= []OWNER 0 OWN6 GENT [I CONTRACTOR AGENTD ENGINEER El DEVELOPER 0 TENANT G/y' CONTACT NAME E-MAIL STREET ADDRESS CITY,STATE,ZIP row DESCRIPTON Cir // [INGLE-FAMILY/DUPLEX S ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL STING USE EXISTING SN NEW FLOOR SF PORCH SN DECK SP DEMO SA STORIES Y TOTAL NET SP USE TYPE OCC SQ.FT, VALUATION($)MODEL REMODELKITCHEN REMODMOTHR GARAGE ❑ATTACHED THROOM SF SF SF SF ❑UE'I'ACIIED SING ❑YES gICHLHR YGS SECOND STORY ADDITION ❑YES E SPRINKLERS❑NO ❑NO ❑NO DWELLING SECONDDWELLING EiYES❑ATIACIIED❑DETACHED OTHER UNITS p UNIT ADDITON: ❑NO S E POOLS ❑FIBERGLASS Q VINYLLINED ❑GUNITE ❑PREFABRICATED POOL-SP SPA-SP SPA ATTACHED AYES ❑NO TOTAL-SF tIAT� REC IVE CouuPercini or Multi-Pnn ily Blr'Idinrs si9e Pu6iie Swirnn ire Pnols req Fres Depn to eito(Ee v' citnl Henfl nn Deal RE-BOOP L+XISI'ING ROOF TYPE: ❑BUILT-UP BOOP❑ASPHALT SHINGLES[-]WOOD SHAKES E]WOOD SHINGLES ]TILE OTHER((SSPECIFY) REMOVE/REPLACE Q NO IF NO PLYWOOD ❑V`" ❑3/8" PLYWOOD TYPE: PITCPI: ROOF CLASS ❑YES #OF LAYERS THICKNESS ❑51r OTHER ❑OSB L]COX OTHER •12 A PROPOSED ROOF'FYPM 1:1BUILT-UPROOF 11 ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑OTHER 'Provide a signed copy of the Cupertino's Tear-Off Policy SP #.f 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 purposes. I acknowledge and authorize all information contained on this application form to be made available for public recordG,✓" ��✓�� Signature of Applicant/Agent: - Date: ! SUPPLEMENTAL INFORMATION REQU ` *New SFD/Second Dwelling Units/Mulfi amily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings:Provide.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 Bldg tpp_2017.doc revised 08101117