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B-2019-1077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-1077 20010 RODRIGUES AVE APT A CUPERTINO,CA 95014-3160(369 03 008) Lake Biltmore Apartments 1900 S.Norfolk St Suite 150 San Mateo,CA 94403 OWNER'S NAME: Lake Biltmore Apartments DATE ISSUED:06/19/2019 OWNER'S PHONE:650-931-3400 PHONE NO:650-931-3400 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor Lake Biltmore Apartments Date 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: THE BILTMORE APARTMENT-REMODEL APARTMENT-UNIT F I hereby affirm under penalty of perjury one of the following two declarations: "STRATFORD"REMODEL BATHROOM(58 S.F.);REMODEL 1. I have and will maintain a certificate of consent to self-insure for Worker's KITCHEN(90 S.F.);REMODEL OTHER(55 S.F.);(N)LIGHTS(6);(N) Compensation,as provided for by Section 3700 of the Labor Code,for the OUTLETS(2);(N)CONDENSOR/FAN COIL SYSTEM.FLOOR PLANS performance of the work for which this permit is issued. ARE ON MASTER PERMIT B-2017-1522. 2.\, 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: Valuation:$20268.00 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 69 Number: Occupancy Type: 3 and state laws relating to building construction,and hereby authorize 369 03 008 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 an will comply with all non-point source regulations per the Cuperti 0ilu�cipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature _ i Date 06/19/2019 Issued by:Jasmine Archbold Date:06/19/2019 OWNER-BUILDER DECLARATTiuN. 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 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) I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: euntractors to construct the project(Sec.7044,Business&Professions Code). Date:06/19/2019 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 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 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 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Fhapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Secti sQ5505,2553 ,a 25534. Labor Code,I inust forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:06/19/2019 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDIN AGE 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 t rmance 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 regp1ations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date 06/19/2019 Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333*building@cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ZALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT ESS bR� � T APN# PROJECT ADDRF. OWNER N FE126 PH N E-MAIL ao M E L lKe 50 STREU ADDRE ` CITY, STATE,ZIP FAX D v®) .�•�� CONTACT NA , PHONE E-MAIL t9o arrr if�'1��v1' STREE /DSD ES CITY,STATE ZIP CA-. 9 YY0 FAX �r WM ❑ OWNER ❑ OWNER-BUILDERY_Q�R AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Remodel Apartment: UNIT B "STRATFORD". Remodel Bath (58 S.F.); Remodel Kitchen (90 S.F.); Remodel Other (55 S.F.); New Lights (6 Total); New Outlets (2 Total) ; New Condensor/ Fan Coil System. Floor plans are on Master Permit Number B-2017-1522. EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ®YES BEING ADDED? ❑NO ADDITION? ®NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES IVED BY: TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO Q© o 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 reNd this application and the information I have provided is corre t.I h read the Description of Work and verify it is accurate.I agree to comply with all applicable local ordinances and state laws relating to bui rig c nstru o I ut orize represe atives of Cupertino to enter the above identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATIONtffQUIRE PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ WfILDING PLAN REVIEW existing building(s).Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIENV Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ Pt'BLICWORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ �I..IOR ❑ SANITARI'SE-*A'ERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgA,pp_2011.clot revised 06/21/11