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13020085CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20590 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 13020085 CONSTRUCTION, INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED: 02/142013 OWNER'S PHONE: 4084480700 - CAMPBELL, CA 95008 PHONE NO: (408)379-5500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class ✓ Lic. # 7 REMOVAL OF INTERIOR LIGHT FIXTURES Comms Date V4Z"�� I hereby affirm that 1 am Iicens under the provisionsof (commencing with Section 70 of Division 3 of the Business & Professions Code and that my license is i full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $500 performance of the work for which this permit is issued. 1 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 APN Number: 32610066.20590 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN0 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the a granting of this permit. Additio , the applicant understands and will comply Issued by: Date: with all non-point source re a s per the Cupertino Municipal Code, Section 9.18, RE-ROOFS: Sign D 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I aro exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Ba r a Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with th u no Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &fety Code o , 25533, and 3 Section 3700 of the Labor Code, for the performance of the work for which this Dater�� permit is issued. Owner or authorized e I certify that.in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 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 City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date 3 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION /I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 n (1r U CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(akuoertino.ora ❑ NEW CONSTRUCTTON n ADDITION 'RAITCRATTnW l" F1 Dctncrnwr nD�rnr.r n PROJECTADDRESS n^S '/ APNW 0W'U 8 Oi' Gr'J/ G%i PHO:J _ ^G� -c376c EMAIL D6a.b STREET ADS /tea �/ �r,. f//✓ J CITY. STA�TE�P�� F CONTACT NAM Gh T/"Y/EJT-J `EY' PHO E-MAIL %- /Y/Ei0/d �� -796- 65a sob f , cam. STREET /Y. ADDW606 _ / %%�0 / .I-1 U �•/ ��/�/7C.' CJd� /%"" T L g__�fo_�jS )(OWNER ❑ OWNER-BUHDM ❑ OWNERAGENT ❑ CONTRACTOR. ❑OONTRACTORAGET.T ❑ ARCmItiCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTO�.jt� Q9 //lu LICIIJSE NUMBEIt��/�� LICENSE 7YPEB BUS.LICN56� COMPANYNNAAMED �•!�/9//�liB`/✓Z// - E"L.r-- f�T ,SEsC/,. cz✓r> �7r7-�ZS6 STREET ADDRESS 711,P f/ CITY, STATE, ZJ ARCFBTELT/ENGINEERNA�1FitLha [�CL LICENSE NUMBERC�/`�� BUS. LCa COMPANYNAME I✓=jCi Mph �LQ/'OW.Sk/�9/Z'f�'✓i J�'.l�i. �.G' FAX �.—�TG ��'r/ STREET ADDRFSjy�A/�� 8/✓�� CT'. STATE, ZIP\G�� i� •��,/� V`��V PH-�py/(D ! DESCRIPTION OF WORK iJ��✓9/ �J / .�� EXISTING USE PROPOSED U$E CONSTR.?YPE NSTORMS USE TYPE OCC. SQ.FT. VALUATION / (S) EXLSTO NEw FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA RD40DELARFA REMODELAREA PORCH AREA DECK AREA TOTALDECKJPORCH AREA GARAGEAREA: DETACH ATTACH I pDWEL.INGUNRS: ISASECONDUNIT OyEs SECONDSTORY OYES BEINGADDED? ONO ADDRIONT ONO PR APPLICATION ❑YES IF YES, PROV=E COPY OF PLANNING APPLP ❑NO PLANNING APPROVAL LETTER Is THE BLDG AN ❑YES EICHLER HO1WV ❑NO RECEI TOTAt•VALUATION: _ /' (this By my signature below, I certify, to each ofthe following: I am the property owner or authorized agent to ac oR a property, owner's behalf. I have read application and the information 1 have provided is wn=L -I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws red Wng4 'kung constructi 1 a rize fives of Cupertino to enter the above.#cridged property for inspection purposes. Signature ofApplicam/Ag Date: ✓ SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECKL�E2 ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ", r{wrill VI NO PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building .kbVEe-THE'COUNTFR1. permit for new building. ❑ EXPRESS- ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure - ❑ STANDARD. ❑ PHBI IC coot ics Tom if any Hazardous Materials are being used as part of this project ❑ linacE - ❑ ETRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑-SANRARY submival of Building Parmit application. MAJOR SEWER DISTRICT ❑.,,ENVIRONMENTALHEALTH'..:". BldgApp_201 1. doc revised 06121/11