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B-2016-2011
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2011 23300 VIA ESPLENDOR UNIT 60 CUPERTINO,CA 95014-6549(342 55 045) BAY AREA ENTERPRISE SAN JOSE,CA 95148 OWNER'S NAME: FULLER ROBERT H TRUSTEE&ET AL DATE ISSUED:05/25/2016 OWNER'S PHONE:650-537-1523 PHONE NO:(408)238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class_GENERAL BUILDING CONTRACTOR Lic.#817817 Contractor BAY AREA ENTERPRISE Date 03/31/2017 X BLDG X 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: UNIT 60-ADD(1)12 LED RECESSED LIGHTS,2 GFCI,2 OUTLETS, I hereby affirm under penalty of perjury one of the following two declarations: 3 LIGHT SWITCHES. 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 permit is issued. Sq.Ft Floor Area: Valuation:$6500.00 APPLICANT CERTIFICATION 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 342 55 045 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. 180 DAYS FROM LAST CALLED INSPECTION. Signature LG Date /25 5/216 Issued by:Abby A,ey nde Date:05/25/2016 (� OWNER-BUILDER 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 r. 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) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:. contractors to construct the project(Sec.7044,Business&Professions Code). Date: /25 5/216 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 s. 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 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 Qua l' Management District I Worker's Compensation.laws of California. If,after making this certificate of will maintain compliance with the Cupertino 2559.al Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 25505 5533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. ry,owner or authorized agent: APPLICANT CERTIFICATION Date:5/25/216 I certify that I have read this application and state that the above information is CO NSTRtCTION LENDING AGENCY 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 the performance 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. l understand my plans shall be used as public records. Licensed Signature Date 5/25/216 Professional CONSTRUCTION PERMIT LI ` K t COMMUNITY DEVELOPMENT DEPAITI MENT Q BUILDING DIVISION 40300 TORRE AVENUE o CUPERTINO,Ch 95614-3255 t3f�El ` I $t (408)777-3228•FAX(408)777-3333-buildinot;ris uper ino.or bbl' NEVX'CONSTRUCTION ❑ ADDITION TERATI ,,,t TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT PROJECT ADDRESS i P ? F-3 23 3 V s a le or - . - ®*57' `.. 016',LER NAME PItrINE E\TAIL 31a �rla#� r e Ike t,r a- 3 _ 152.3 ,- a a s SC •tars STREETADDRESS2 O Via Lam' as 1 CI6+Ty,STAfE ZIP CA A I FAX CONTACT vAntE&--e :Fr; 5-tP O�e -2-3 e r 5 y-3 E-MAIL a-r—et , ..c o" STREETADIIRE5S Crnr.STATE,ZIP FAX Zile> r V1 `yi Wrl sx- Sl 0 OA'NER ❑OWNER-BUILDER ❑OWNER AGENT Z(=oNTRAarop ❑CONTRACTOR AGENT ❑ APCHiTECT 0 ENGINEER: 0 DEVELOPER 0 TENANT £ONTRACTOR.NAt lE LICEiNSE NUMBER - LICENSETYPE BIS.LIC 4 COlIPr1?IY NA•1E r £.1t3IL FAX Q 1M18 fi Yt if' S r'e c3. �ti~S .[.C STREETADDRESS CITY,STATE,ZtP PHO . tT A ARCH FECTIENGINEERNAME LICENSE NUMBER BII$_LIC T COMPANY NAIVE• L--MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTIONOF W RIC 1 Etaxi &s4 1tP' of c - I u( �-, y.. __ vsi` TYPE oCC_ sQ.Fr_ VALUATION(si EXTSTG NEW FLOOR DEMO TOTAL _ AREA AREA. - AREA NETAREA BATHROOM- KITCHEN- .OTHER REN40DEL AREA REN40DEL AREA REMODELAREA - a: PORCH AREA DECK AREA TOTAL.DECKIPORCH AREA I GARAGE AREA: ODFTACH OATTACH- B DWELLING UNITS- ISASECOND UNIT - OYES SF.CONDSTORY ❑YES BEING ADDED? ONO ADDITION? QNO pRE-APPLICATION DYES IF YES,PROVIDECOPY OF IS THE BLDG AN: DYES - V RE D BY: TDTgIL VALCI N: PLANNING ADPL E ONO PLANNING APPROVAL LETTER EICHLER HOME? [SND k• By my signature below-,I certify to each of ti Ie follow g: I ani the property owner or authorized agent t act on �i property owner's behalf I ave read this application and the information I have provided is co ct. I haWlead the Description of Work and verify it is accurate. T agree to comply with all applicable local ordinances and state taws relating to building cons ct9on. lWoorize representatives ofCupertmo to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: SUPPLEMENT41L INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _Neiv SFD or Multifamily dwellings: Apply for demolition permit for © nvER TI CattNTER fl BUILDING PLAN REVIEW existing buitding(s}. Demolition permit is required prior to issuance of building permit for new building. D MRESS ❑ PLNNNIi4GPLAN REVIK%'Y _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E STANDARD PUBLIC WORKS Tor—mi if any Hazardous Materials are being used as part ofthis project. ZRGR ❑ FIRE WEPT _Copy of Planning Approval Letter or Meeting with Planning prior to [l IIVIAaaR fl SANITARY SEWER DISTRICT submittal of Building Permit application. j fl ENVIRONMENTAL HEALTFI B1dgApp 201 Ldoe""revised 06121111 IVU_- �F .r ;E sf5 UFFICE COPY - 1I 1 1 rte- a_ €` 1 i I 1 r I j j l IQ I— , —1� I :J vinRoe tt p rt -191-xi 3 { � w - 4-4 11 �- C- 9 r- �, ixi OO ...... CF j an L COMMUNITY DEVELOP I I � _ BUILDING DIV€SIGN � t r I i -T1 € APPIR This srat of plans and specifioa —— job sitz during construction. It is ural A I io r changes or alterations on same, thQreromr without approval from the 0 0" - Thin,stamping of this plan and specific o hold to ermit or to be an approvl �d t,e�v� tl n, � � ;- p - of any provisions of any City Ordinae t- BY blu AtLv't�— DATE r if i I 6 PER',-MIT NO. 'Zk'�°�, 4 4� Emergency Response System 0 Electrical Outlet © Cable Television Outlet -a Telephone Outlet ; ? =I foot a330(2 Wq �5 ,vim 'f�V - i✓�(p�1 Stanlard Villa (o 0 INTERIOR LIVING SPACE �70"v1,280 TOTAL Square Feet Two Bedrooms Two Baths TT/0 DECK SPACE 190 Square Feet AT RANCHO SAN ANTONIO Floor plans are representative.Actual measurements and Iayout maY vary.