The URL can be used to link to this page

B-2016-1739CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1739 1539 POPPY WAY CUPERTINO, CA 95014-5306 (366 15 030) ALBERT CONSTRUCTION HALF MOON BAY, CA 94019 OWNER'S NAME: DESAI RANJIT AND PRIMA TRUSTEE DATE ISSUED: 04/11/2016 OWNER'S PHONE: 408-688-7464 PHONE NO: (650)245-9787 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO; License Class 5 Lic. #941774 Contractor ALBERT CONSTRUCTION Date 91/31/2018 XBLDG _ELECT XPLUMB 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: EXTEND GAS PIPE 25 FT FROM GARAGE TO KITCHEN I hereby affirm under penalty of perjury one of the following two declarations: i.. 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. z.r'I have and will maintain Worker's Compensation Insurance, as provided for by 14-C Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $450:00 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 APN Number; Occupancy Type: and state laws relating to building construction, and hereby authorize 36615 030 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. 1$0 DAYS FROM LAST CALLED INSPECTION. g SS ture Date 4/11/2016 Issued by: Abby Ayende VLA Date: 04/11/201629 OWNER-_BXMDER 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 3. 1, 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) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/11/2016 I hereby affirm under penalty of perjury one of the following three declarations: - ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 1 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 ofthe 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, l 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, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked.�C or authorized agent; APPLICANT CERTIFICATION Owner s -Date: 4/11/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 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 4/11/2016 professional CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org PROJECT ADDRESS 00 APN# ViOVV�' /'(� �j� OWNERNAME C�jg;( Wl VE"a I pS ( PHO p. tadSG� 7T4 E-MAIL STREET ADDRESS CITY, STATE, ZIP _ FAX CONTACT NAMEr f PHONE ,4�)'S7 p E-MAIL STREET ADDRESS (� CITY, STATE, ZIP J EF El OWNER ❑ OWNER-BUIIAER ❑ OWNER AGENT .Il—,CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS. LIC # C? r L 9 f7 '3�r52-V COMPANY NAME E-MAIL FAX 1. c' Y �-iJ'Y9 S YlR w • 7 L ` i% Y' i� �::'i f f�Y� STREET ADDRESS :7- ri)Vo f CITY, STATE, ZIP Q � PHONI{ /� �� _ ARCbIITECT/ENGINTEER-NAME `J� LICENSE NUMBER 7 BUS.LIIC## ,L COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE; ZIP PHONE USE OF-?.SFD.rDUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: El COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLERHOME? ❑ NO DESCRIPTIONT OF WORK r jj MEPMiscApp_2011.doc revised 06121111