B-2019-0757 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0757
10191 PHAR LAP DR CUPERTINO,CA 95014-1113(326 39 053) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: DATE ISSUED:05/02/2019
OWNER'S PHONE:408-892-5614 PHONE NO:(901)271-9700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 C42 A Lic.#765155
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG —ELECT X PLUMB
Date 07/31/2020 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 JOB DESCRIPTION:
license is in full force and effect. REPLACE ALL DRAINS UNDER THE HOUSE-(4 FIXTURES)
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.
�. 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:$10500.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 326 39 053
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additional'y,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations perlhbNQupertino Municipal Code,Section 9.18.
� .� Issued by:Jasmine Archbold
Signature Date 05/02/2019 Date:05/02/2019
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
i. I,as owner of the property,am exclusively contracting with licensed Date:05/02/2019
contractors to construct the project(Sec.7044,Business&Professions Code).
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
Date:05/02/2019
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
{;' 1.0300 TO.RRE AVENUE • CUPE.R.TINO, CA 9501.4-3255
40 777-3228 * u i i r tCrLt� r .0.O r PERMIT#B
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION [:]ALTERATION ❑T.I. Q MEP ❑RE-ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS APN#
10191 PHAR LAP DR 326-39-053
OWNER NAME PHONE E-MAIL
LYNN BONICELLI 408-892-5614
STREET ADDRESS CITY, STATE,ZIP
10191 PHAR LAP DR CUPERTINO,CA 95014
0 CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
RESCUE ROOTER ARS RESCUE ROOTER 765155 C36 C42 A
STREET ADDRESS CITY,STATE, ZIP
2305 PARAGON DR SAN JOSE,CA 95131
P
PHONE BUS.LICVCAO@ARS.COM 408-982-0405 403526
CHITECT ❑OWNER ❑OWNER AGENT ❑x CONTRACTOR AGENT[I ENGINEER❑DEVELOPER[:1 TENANT
CONTACT NAME E-MAIL
VAN CAO VCAO@ARS.COM
STREET ADDRESS CITY,STATE,ZIP PHONE
12305 PARAGON DR SAN JOSE,CA 95131 408-982-0405
DESCRIPTON ._.�
REPLACE ALL DRAINS UNDER HOUSE
OSINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL ❑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
EXISPRINKLERS SING F1YES
EICHLER ElNOS SECOND STORY ADDITION [:]YES
E] NO [:1 NO NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED[]DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F
POOLS ❑ FIBERGLASS []VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED DYES ❑ NO TOTAL-SF
�EIVED BY: TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public Szvinuning Pools requires Department of Environmental Heath approval ,N, 10,500
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1�2 ❑3/8" PLYWOOD TYPE: PITCH: •12 ROOF CLASS
El YES #OF LAYERS THICKNESS[:]5/8 OTHER [:1 OSB [:]CDX OTHER 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 and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property If6r ins pection_yjlrpoI acknowledge and authorize all information contained on this application form
to be made available for public rec `d. ,,__
Signature of Applicant/Agent:. Date:5 2 19
g .,.,...
SUPPLEMENTAL INFORMATIO SQUIRED
'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.
'WHOA-Provide a letter of approval from the Home Owner's Association
B1dgApp_2017.d6c revised 08101117