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D-2017-0020CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0020 18000 CHELMSFORD DR CUPERTINO, CA 95014-641 (375 22 104) JAMES STEEL ENGINEERING BEN LOMOND, CA 95005 OWNER'S NAME: TANTAU PARK REC AND PY DIST OWNER'S PHONE: 408-406-8858 License Class A Lic. #1003641 Contractor JAMES STEEL ENGINEERING Date 05/31/2019 I hereby affirm that I am licensed under the provisions of Chapter 9 (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: t. I have and will maintain a certificate of consent to self -insure for Worker's G Compensation, as provided for by Section 3700 of the Labor Code, for the -F, performance of the work for which this permit is issued. 2. 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. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understandsand will comply with all non -point source regulations per th9e,Et;pertin()Aunic;)ai Code, Section 9.18. Signature Date I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). DATE ISSUED: 05/04/2017 PHONE NO: (831) 713-0961 BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB MECH RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: INTERIOR NON-BEARING WALL AT LIFE GUARD ROOM. Sq. Ft Floor Area: I Valuation: $1000.00 "N Number: Occupancy Type: 37522 104 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 05/04/2017 RE -ROOFS: 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. Signature of Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR 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. z. 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. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertin Municip Code, Chapter 9.12 and the Health & Safety Code, Secti 25505, 533, 25534. Owner or authorized agent: Date: CONSTRU 4N �i� G AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buddino(�cuDertino.org F1 NEW CONSTRUCTION ❑ ?ADDITION ❑ ALTER.ATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT YROIECT .ADDRESS PSN L� 5 al 35 'Z Z f0 OWNER NP-N4E-- l•/,� STREET.ADDRESS ( CITY, STATE, ZIPP / (0 ram C FAX 0 v7 J �� V farlA U, 1.-71 /�/ CONTACT N.A.ME J � l I PH04= JIG((} �OSrIt�V ` f ��)• J�7°��.��e��IrG-� f�l��w STREET ADDRESS CITY, STATE, ZIP FAX C3 OVVNER ❑ 0\\'.kTFER�BUILDER ❑ OV,TERAGEAT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ?ARCHITECT ❑ ENGLNEER ❑ DEVELOPER ❑ TENA^'T C0I\TRACTORNAl4EjM LICENSE\?E � �f E� s/00y/ T S.LIC4' s�3 COMPANY NA14E - E-1 AIL. FAX STREET ADDRESS CITY. STATE, ZiP, PHONE .ARCHITECT/ENGLNEER N.AMIE �---�! ---�' ICE'\SE?\-liMBER_�," BUS.. LIC - ---_- - H�� COMPANY NAME L �T r/ �N Alp • �,..Iv STREET ADDRESS . C1 Y, S ATE ZIP PHONE - DESCRIPTION OF WORJ: --- EXIST-NG USE ( PROPOSED USE CONSTR T}PE a STORIES USEI 'TYPE OCC. I SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR. AREA DEN'O i TOTAL AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REhiODELAREA PORCHAREA DECK AREA TOTAL DECKPORCH .ARE.A I CARAGEAEFA: DETACH ❑ ATTACH I DWELL2d0 UNITS: IS A SECOND L'\IT ❑ YES SECOND STORY ❑YES _ BELNG ADDED? ❑ NO .ADDITION? []NO PRF -APPLICATION [I YES IF YES, PROVDE COPT OF 1S THE BLDG.A-N ❑ YES TOTAL VALUATION: PLP.NTTNG.APPL-- ❑NO LETTER EICHLERIOME? No By my signaturee below, I certify to each of the following: I am the property owner or authorized a_ nt t t on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of \York and v t is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildift c%nstructlon. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: — Date: / Z 6z 1 SUPPLEMENTAL 1 FORA2ATION REQUIRED PL i cPiEci TrPE ° ioti> InG silP 1D OVER -THE CoL-NTER " C Bt ILDI-Nc PL.''; RE En' •' New SFD or Multifamily dwellings: Apply for demolition permit for existi,g building(s). Demolition pewit is required prior to issuance of building _ permit for new building. fl E,l'PREss D PLANNING PLAN r.EV IEW3 Commercial Bless: Provide a compleied Hazardous !%Ia,enais Disclosure D' STANDARD . D PLSLIC WORKS _ form if any Hazardous Materials are being used as part of this project. ` El' LARGE FIRE DEPT` _ Copy of Planning Approval Letter or Meeting with Planning prior to LAJOR D' SA',IIARY sE� EiiDIcT>ticr submittal of Building Permit application. 0- E 'IRO\I fE\T.kL HEALTH Bldgpp_2011.doc revised 06/21/.'1 OVERALL GROUND FLOOR KEY PLAN A1.D SCALe 1/16-1 -0' PARTIAL GROUND FLOOR PLAN A1.0 SCALE: 114-V-0" DEMOLITION GENERAL NOTES: LEGEND: LINE TYPES: EXISTING SHEET NOTES: OMnmNEFE�YSENF. N-ST—TURA INTERIOR —TITION. FINISH F0 INTERIOR NON-STRUCTURAL DEMOLITION