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11040047CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18880 HOMESTEAD RD CONTRACTOR: DEVCON PERMIT NO: 11040047 CONSTRUCTION INC OWNER'S NAME: APPLE 690 GIBRALTAR OR DATE ISSUED: 04/07/201 1 OWNER'S PHONE: 4089428200 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTQR'S DECLARATION r r r 22 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # S,3191r r r --tt'� _� (� n, MECH RESIDENTIAL COMMERCIAL Contractor � V t"�A1 �� Date l hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: T.1722 SQ FT INTERIOR WORK ONLY NO M,E,P'S (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $32000 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 whiclipthis APN Number: 31609037.00 Occupancy Type: permit is issued. �� APPLICANT CERTIFICATION 1. 1 i.� I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 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 DAYS FROM 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 granting of this permit. Additionally, the applicant understands and will comply Issued by. Date: with all non- int source regu tions per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Sigtlxitur.:C Date • / 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I, 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. I 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 Bay Ar Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit e p ti Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se 'o s 55 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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, I 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 1 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cupertino.org PION ❑ ADDITION [9 ALTERATION 1 TI ❑ REVISION J DEFERRED ORIGINAL PERMIT # PRO D SS TPNII O 3 L O -T PHONE Q �^ E-MAII C- STREET ADDRESS S A ZIP 1 F CONTA PHO -MAII, � 1 STREET D S , STIA ZIP F _ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT �CONTRACrOR ❑IcoNTRAcTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO NA LICENSE N LICENSE E BUS. LIC k COMP E-MAII. F _ 771 STREE DRESS ZIP n ` ONn P � Z` ARCF�C7N � � LICENSE BUS. LIC k COMP F J S T SS TTY• ATE, ZIP P DESCRIP OF WQ Q C L PJQSTINGUSE,? PROPOSED LSE CONSTR. TY!' kSTOR�S ys�,3t`Fj' Y;, _ .. �,� • ,y -x; Y' ifs ". �y� s'.!'S';,44^�. rs< •, - ''�>fr�'•e. �I- rE ✓. ,L� EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - V•� ' -•• . BATHROOM KITCHEN OTHER I s �: xs., REMODEL AREA REMODEL AREA REMODEL AREA r .,-. - ¢` IN A PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑ DETACH ti 'Md i s g is -• x ' •` k[;� hi', pp 'p•' ? ; '; � ❑ ATTACH � ,•��F?: .a- %' '• ��. e--`i;z-� I M DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES .? v r ,S fit;-< , •y- ` D' S r BEING ADDED? ❑ NO ADDITION? ❑ NO F :vr ! PRE -APPLICATION ❑ YES IF YES. PROVIDE COPY OF PLANNER'S NAME +!t ;' 4:v': KI •'�1 S 1 i . }7'` '7��•-�'r PLANNING APPL M ❑ NO PLANNING APPROVAL LErrER .. PUE I� By my signature below, I certify to each of the following: I am the property owner or authorizes agent to act on the property owner's behalf. I have d this application and the information I have provided is comet I have read the Description of Work and verify it is accurate. I agr to comply with all applicable local ordinances and state laws relatin buil ' g c i I authorize representatives of Cupertino to enter the above-' ntifi d property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL RMATI N REQUIRED - New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: 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 ofBuilding Permit application. ;�r; �,�,-s„'r�,�'�r.s�? f �:5��x3 �'i lv >:j r�i ,,t�"u� •' t`•.�.rS3i ,ry . �� t`,'F`c:":;"�'s.-<<in��.sFui��i� • O R� ,�• , �,hs• r: a BldgApp_201 Ldoc revised 03116111 Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # a1 Z GENERAL CONTRACTOR: C BUSINESS LICENSE # ADDRESS: Q CITY/ZIPCODE: M k u *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile S I ate