B-2018-1025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1025
21428 METEOR DR CUPERTINO,CA 95014-1325(326 44 049) ROCKWOOD
CONSTRUCTION
CORP
SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED: 11/07/2018
OWNER'S PHONE: PHONE NO:(408)568-6474
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class A.B Lic.#685684
Contractor ROCKWOOD CONSTRUCTION CORP Date 04/30/2020 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
CONSTRUCT(N)SFD-(3884.76 SF);ATTACHED GARAGE-(459.61
I hereby affirm under penalty of perjury one of the following two declarations: SF);(1)COVERED PORCH-(247.11 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's DEF#1 -TRUSSES-ISSUED 05/13/2019
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 Floor Area:3885 Valuation:$900000.00
APPLICANT CERTIFICATION
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 26 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 326 44 049 R-3(Custom)
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 05/13/2019 Issued by:Haley McKee
Date: 11/07/2018
3
OWNER-BUILDER DECLARATION
I hereby affirm that I am 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
installed without first obtaining an inspection,I agree to remove all new materials for
i. I,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 inspection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/13/2019
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. I 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,Secti ns 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent`: �
APPLICANT CERTIFICATION Date:05/13/2019
certify that I have read this application and state that the above information is CONSTRUCTION LE ING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction I6nding 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 05/13/2019 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE a CUPERTINO, CA 95014-3255
(408) 777-3228 * building@cuperfino.org PEMIT#B-
CUPERTINO REV# DEF 9
EN NEW CONSTRUCTION [:]ADDITION []ALTERATION 0 T.I. El MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN L
'0211eds LCI
OWNER NAMEU141AI-1,4971YI PHONE E-MAIL
WAD H VV4
STREET ADDRESS CITY, STATE,ZIP
❑CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
STREET ADDRESS
CITY,STATE, ZIP
E-MAIL PHONE BUS.LIC# C)L
OD ARCHITECT [I OWNER El OWNER AGENT CONTRACTOR AGENT[I ENGINEER El DEVELOPER El TENANT
CONTACT NAMY,� E-MAIL
4�2
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTON
P!15,INGLE-FAMILY/DUPLEX El MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISING [1 YES EICHLER El YES SECOND STORY ADDITION [:]YES
FIRE SPRINKLERS M NO ❑ NO El NO
DWELLING SECOND DWELLING El YES []ATTACHED E]DETACHED OTHER
UNITS# UNIT ADDITON: El NO S F
POOLS1 ❑FIBERGLASS [:]VINYL-LINED [:]GUNITE ❑ PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED[3 YES El NO TOTAL-SF
RECEIY,EQ BY: TOTAL VALUATION:
Commercial or Multi-Familil Buildings with Public Swimming Pools requires Department of Environmental Heath approval YA
RE-RO OF EXISTING ROOF TYPE: 7 BUILT-UP ROOF 7 ASPHALT SHINGLES F WOOD SHAKES❑WOOD SHINGLES ❑TTLE� OTHER(SPECIFY)
REMOVE/REPLACE M NO IF NO PLYWOOD 7 /2" [—]3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
El YES #OF LAYERS THICKNESS F]5/8" OTHER []OSB 7 CDX OTHER :12 A
PROPOSED ROOF TYPE: EIBUILT-UP ROOF DASPHALT SHINGLES OWOOD SHAKES DWOOD SHINGLES EIOTHER
'Provide a signed copy of the Cupertino's Tear-Off Policy SF 4of 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..,.1..__knowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date:
V
SUPPLEMENTAL INFORMATION REQU RED
*New SFD/Second Dwelling Units/Multifamily Dwelli s: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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1025
21428 METEOR DR CUPERTINO, CA 95014-1325 (326 44 049) ROCKWOOD
CONSTRUCTION
CORP
SARATOGA, CA 95070
OWNER'S NAME: DATE ISSUED: 11/07/2018
OWNER'S PHONE: PHONE NO: (408) 568-6474
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class .a, b Lic. #685684 XBLDG ELECT PLUMB
Contractor ROCKWOOD CONSTRUCTION CORP Date 04/30/2020
— — —
MECH X RESIDENTIAL — COMMERCIAL
I hereby affirm that I 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:
CONSTRUCT (N) SFD - (3884.76 SF); ATTACHED GARAGE - ( 459.61
I hereby affirm under penalty of perjury one of the following two declarations: SF ); (1) COVERED PORCH - ( 247.11 SF)
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.
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: 3885 Valuation: $900000.00
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 Number: Occupancy Type:
326 and state laws relating to building construction, and hereby authorize 326 44 049 R-3 (Custom)
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 11/7/18 Issued by: Haley McKee
Date: 11/07./2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am 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. I, as owner of the property, or my employees with wages as thein 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: 11/7/18
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. I 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,
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. .�'. .,,-..
Owner or authorized agent: -
APPLICANT CERTIFICATION Date: 11/7/18
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 Lenders 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.
Signature Date 11/7/18 Licensed
Professional