B-2016-3189 CITY OF CUPERTINO BUILD G PERMIT
BUILDING ADDRESS: CONTRACT SR: PERMIT NO:B-2016-3189
22639 OAKCREST CT CUPERTINO,CA 95014-0830(342 48 011) SHAUL E
THOUSAND•AKS,CA
91362
OWNER'S NAME: COVEN ERAN AND IRIS DATE ISSUED:12/01/2016
OWNER'S PHONE:40 -483-3063 PHONE NO:(818)561-9204
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B. tic.#874309
Contractor SHAUL EINjt'Date 03/31/2018 X BLDG X ELECT _PLUMB
T hereby affirm that I a licensed under the provisions of Chapter 9(commencing —
MEM X RESIDENTIAL_COMMERCIAL
with Suction 7000)of Di 'sion 3 of the Business&Professions Code and that my
license is in full force an effect. JOB DESC I' 'TION:
ADD 14 LEI) LIGHT FIXTURES-LIVING ROOM AND DINING
I hereby affirm under malty of perjury one of the following two declarations: ROOM
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 o the work for which this permit is issued.
JI, fit
<‘,.. .7 I have and wi maintain Worker's Compensation Insurance,as provided for by
it Section 3700 f the Labor Code,for the performance of the work for which this
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permit is issued. Sq.Ft Floor ea: Valuation:$750.00
cl APPLICANT CERTIFICATION
I certify that I have rea this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Numbe : Occupancy Type:
and state laws relating o building construction,and hereby authorize 342 48 011
representatives of this city to enter upon the above mentioned property for
inspection purposes. I e)agree to save indemnify and keep harmless the
City of Cupertino again t liabilities,judgments,costs,and expenses which PE' I T EXPIRES IF WORK IS NOT STARTED
may accrue against sal City in consequence of the granting of this permit. WIT I 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applic nt understands and will comply with all non-point
source regulations pe .he Cuperti Municipal Code,Section 9.18. 180 D S FROM LAST CALLED INSPECTION.
/
Signature O � Date 12/1/2016 Issued by: .bby Ayende
ff Date:12/01 016
OWNER-BUILDER DECLARATION
I hereby affirm that I a exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs sh.I be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of e property,or my employees with wages as their sole installed with.ut 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.704 ,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of pplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:12/1/20 6
I hereby affirm under p natty of perjury one of the following three declarations: ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and wi
maintain co ,pliance with the Cupertino Municipal Code,Chapter 9.12 and the
it maintain a Certificate of Consent to self-insure for Worker's
Compensatio ,as provided for by Section 3700 of the Labor Code,for the
performance f the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and wi maintain Worker's Compensation Insurance,as provided for by I have rea i the hazardous materials requirements under Chapter 6.95 of the
Section 3700 f the Labor Code,for the performance of the work for which this Californi Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issu d.
a. I certify that' the performance of the work for which this permit is issued,I Health&.afety Code,Section 25532(a)should I store or handle hazardous
material. A i ditionally,should I use equipment or devices which emit hazardous
shall not emp oy any person in any manner so as to become subject to the air conte,i',ants as defined by the Bay Area Air Quality Management District I
Worker's Co pensation laws of California. If,after making this,certificate of will maint compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I ecome subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections05,25533,•,d 25534.
Labor Code, must forthwith comply with such provisions or this permit shall .---- -/-_,,,,:--
be deemed re oked.
Owner or a thorized agent .----'
APPLICANT CERTIFICATION Date: ..5 • =
I certify that I have rea this application and state that the above information is CONSTRUCTION ENDING AG CY
correct.I agree to corn ly with all city and county ordinances and state laws I hereby affi that there is a construction lending agency for the performance
relating to building con truction,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 N-me
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 A dress
consequence of the gr nting of this permit. Additionally,the applicant understands
and will comply with al non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understan. my plans shall be used as public records.
Licensed
Signature Date 12/1/2016 Profession..I
T-WtC.0P b189
GENERAL PERMIT APPLICATIONmE p
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. , ., COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
. MISC
-. s.�� 10300 TORRE AVENUE••CUPERTINO,CA 95014-3253.
Ct PERT N (408)777-3228•FAX(408)777-3333•buildinq a(�cuperno.orq
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PROJECT ADDRESS at-39
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OWNER NAME f Co' ( y^ PHONE go - �y��,-).?0(10 E-MAIL f4,74/1,5 c 0./dtta!u T
STREET ADDRESS CITY,STATE,ZIP vpf n§i I 17"U )9)I It r FAX
CONTACT NAME / „f PHONE ((i(q) ((/ e 3 3 E-MAIL
STREET ADDRESS 5A A CITY,STATE,ZIP 5 L FAX
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-BUII,DER ❑ OWNER AGENT ❑ CONTRACTOR 0CONTRACTOR AGENT 0 (ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME 'r r A a �/ LICENSE NUMBER (o 0`,` L�CENSE TYPE /3 BUS.LIC#
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COMPANY NAME E-MAIL _C_ e FAX
2-4-7-4A
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STREET ADDRESS r /44,1,164. CI
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ARCHITECT/ENGINEER NAME LICENSE NUMBER - I BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE.OF 0 SFD orDUPLEX 0 MULTI-FAMILY PROJECT IN WU.DLAND 0 YES PROJECT N ❑YES IS THE BLDG AN 0 YES
BUILDING: ❑CO � i •CIAL URBAN INTERFACE AREA 0 NO FLOOD ZONE i NO EICHLER HOME? 0 NO
DESCRIPTION OF WO.1
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TOTAL VALUATION: 2ECEIV£D BYt
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property own is beh f. I have read this
application and the` onnation I have provided is correct. I have read the Description of Work and verify it is accurate. I as ee to comply with all applicable local
ordinances and state ws relating to building construction. I authorize representatives of Cupertino to enter tine above-identified) property' for inspection purposes.
Signature of Appl ca t/Agent: /11.2. Date: I?- I 10/6 i J
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SUPPLEMENTAL INFORMATION REQUIRED '0
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MEPMiscApp_2011.doc revised 06/21/11
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ERAN COHEN
^��. "�s ��,:I .e. ,. , c. 1:: ;01:=fit ,f-'-'? '.,��. ,a:�,��"'�IA,{,� a.:l:
11/30/201:
To: City of 1 upertino I Building Deportment
10300 Tom Avenue,Cupertino, CA 95014
408-777-32.7
Re: Chan•e of contractors. 1 `
Dear Sir, -
I have deededto stop FVR construction company's work,and hired a new contractor,Shaul Einy
from Zatarconstruction, license #874309.
Please ch nge the name on the permit accordingly.
Yours,
Era Cohen
t