B-2018-1408 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:. CONTRACTOR: PERM If NO:B-2018-1408
10467 MARY AVE UNIT 10467 CUPERTINO,CA 95014-1349(326 52 076) STEPHANIE NAYLOR
720 NORTHROP SAN
JOSE,CA 95126
OWNER'SNAME:SAINT BARINDER SAND KAURHARDEEP DATE ISSUED:08/21/2018
OWNER'S PHONE:408-712-5200 PHONE NO:(408)920-3910
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lie.4769446 X BLDG_ELECT_PLUMB
Contractor STEPHANIE NAYLOR Date 06/30/2019
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
REPLACE HVAC UNIT ON ROOF-SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
v 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.
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 Fluor Area: Valuation:$8600.00
I APPLICANT CERTIFICATION
certify that 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 slate laws relating to building construction,and hereby authorize 326 52 076
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 unde ds and will comply with all non-point
source regulation rtino Municipal Code,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
J
8lgnatu fs Data 08!21/2018 Issued by:Jasmine Archbold
Date:08/21/2018
-B]M L RATI
I hereby affirm that I am exempt from the Contractor's License Law fim one of the RE-ROOFS:
All roars shall be inspected rior to an too in material being installed.If a roof is
following two reasons: P p Y 6 g
r. 1,as owner of the property,ce 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)
x. 1,as owner of die property,am exclusively contracting with licensed Signature ofApplicanc
contractors to construct the project(See.7044,Business&Professions Cade). Date:08/21/2018
I hereby affirm tinder penalty ofperjury one of the following three declarations: ALL ROOF COVERINGS'f0 BE CLASS"A"OR BETTERt. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,us provided for by Section 3700 of die Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardans materiaIs 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,f will
peuiu suet is vented. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 nod the s. I certify that in tine performance of the work for which this permit is issuedHealth&Safety Cade,Section 25532(a)should I store or handle hazardous,I materinL Additionally,should 1 use equipment or devices which emit hazardous
shall not employ any person in any maturer so as to become subject to the air contar inamm;as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with t�tff
C1.npter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety CSe 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall /
be deemed revoked. - Owner or authorized area
t:
APPLICANT CERTIFICATION Date:08/21/2018
I certify that I have read this application and state that the above information is 1 ' ' G AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a constnUiowerfding 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 08121!2018 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ts
(408)777-3228• building,(ocupertino.ori PEMIT#B-Zo( - d,(p Q
CUPERT{NO REV#_ DEP#
El NEW CONSTRUCTION [:]ADDITION ❑ALTERATION❑T.I. [:1 MEP EIRE-ROOF ❑SWIMMING POOL/SPA �-
PROJE�C�ryryT ADDRE53 (] APN N
�V F�
OWNER NAME PHONE &MAIL
STREBTADDRESS CITY,STATE,ZIP
1C7 (a S! v �� CIS Jl
CONTRACrOR NAME ❑OW ER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
S n� l - 7 L C�
STREET DDRESS CITY,ST •,ZIP
N.a. (
E-MAIL 1 PHONE
HUS.LI !I
t `k�kr 2C,•2 403�l
❑AR%RT ❑OWNER❑OWNCn AGENT -C ONTRACTOR AGCNT❑ENGINBER❑DE neLOFER❑TENANT
CO§ACT NA`M,E E-MAIL ` 1
STREETAD RESS CITY,STATE,
DESCRIPTON IP PHONE
2C7 Ck ClS Z(c,
\�
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY EIINDUSTRIAL ❑COMMERCIAL
EXISTING USE I EXISTING SP NEW FLOOR 5F PORCH SF DECK SP DEMOU STORIES Y TOTAL NETSF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODELOT'HR GARAGE 11 ATTACHED
BATHROOM SF Sr SF SF 0 DETACHED
BRIBING ❑YES EICHI.ER Q YES SECOND STORY ADDITION ONO
FIRE SPRINKLERS[I NO ❑NO
DWELLING SECONDDWELLING []YES EIATTACHED[]DETACHED OTHER
UNITS 4 UNITADDITON: D NO SP
POOL$ ❑FIBERGLASS ❑VINYL-LINED[3GUNITE []PREFABRICATED
POOL-SF _ SPA-Sr_ SPAATTACHED DYES ❑NO TOTAL-SF
IVED SY: TOTAL VALUATION:
Con rrmrclni nr Mnlfl-Frrmil HUHdin smitlrP rdlie 3u�inrrnln Pnnls re uires Oerurhnenfn Ermirmnnenfu7 HrntGn r � 4'�ry,.0
RE-ROOF EXISTING ROOF TYPE: []BUILT-UP ROOPQASPHALT SHINGLES[]WOOD 51-IAKES❑WOOD SFINGLES❑TILE OTHER(SPCZY) (� \.JV
REMOVE/REPLACE[INO IF NO PLYWOOD❑r'h" ❑3/8" PLYWOOD TYPH: PITCH: -OFC All
❑1'ES k OF LAYERS_ THICKNESS 1]5/8"OTHER_ ❑OSB ❑CDX OTHER —:12 A
PROPOSED ROOF TYPE:LIBUILT-UP ROOF OASPHALT SHINGLES❑WOOD SHAKES OWOOD SHINGLES❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy sP Vvf 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 mid the information I ha e provided is correct.I have read the Description of Work and verify it is accurate.I agree
to comply with all applicable local ordin ces state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified propert fo cti purposes. I acknowledge and authorize all information contained on this application form
to be made available for public r c
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INPORMA EQ ED
*New SPD/Second Dwelling U i
el
't'
i pwelliI gs:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Builduzgs:Provide a ce.,pl d Hazard us 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
B1dgApp2017.doc revised 0810,11 .2 j�