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B-2017-0682CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0682 10270 STERN AVE CUPERTINO, CA 95014-3687 (375 14 037) SH ROOFING & CONSTRUCTION PALO ALTO, CA 94303 OWNER'S NAME: BURRIESCI LAWRENCE G AND JANICE S TRUSTEE I I DATE ISSUED: 05/04/2017 OWNER'S PHONE: 408-257-7519 1 1 PHONE NO: (650) 290-0955 License Class j3 Lic. #931048 Contractor SH ROOFING & CONSTRUCTION Date 04/30/2019 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 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. 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 r the Cupe ino Municipal Code, Section 9.18. Signature Date45/ /2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. a. 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 5/4/2017 BUILDING PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: KITCHEN REMODEL (98 S.F.); BATHROOM REMODEL (40 S.F.); REPLACE WINDOW (7) - LIKE FOR LIKE TO MEET EGRESS; REPLACE SLIDING DOORS (2); (N) ENTRY DOOR; (I) A/C; UPGRADE PANEL (200 AMPS); SEWER LINE REPLACEMENT; (N) WATER HEATER ENCLOSURE Sq. Ft Floor Area: I Valuation: $88000.00 APN Number: Occupancy Type: 375 14 037 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Aygnde 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 Applicant: Date: 5/4/2017 TO BE CLASS "A" OR BETTER 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 Cupertino Municipal Code, Chapter 9.12 and the Health & SafeWCode, dos 25505, 25533, and 25534. Owner or authorized agen Date: 5/4/2017 CONSTRUCTION LENDING 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 5-aU1-.+- C) �a CONSTRUCTION PERMIT APPLICATION. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINC) I (408) 777-3228 • FAX (4,080a1G 8) 777-3333 • building(-CUportino.om NEW CONSTRUCTION ❑ ADDITION L" ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT 9 PROJECTADDRESS ®Z70 ST'Ga.K. )\Vr—NL7a APN# -3 7 7S f/,_/-037 LAWNERNAMB t w��tct~ .i'hufCE9R�1(�.scl PHONE �0f'"G��/-MAIL `/Of3-'2 7-7-5/9 Lary �i0,'riesci ciflf• i STREET ADDRESS 2.0900 Ai-vEs DRtvE STATE, ZI CITY, G CV ,@r1rnlo CA q 0 FAX CONTACT NAMEPHOrt LA R t! Irz 5 -f `0"k-46,6— ch7� E-MAIL Lctrr .IlvrrriasGi e Lf-/. ne� STREET ADDRESS 2ogao A%.vcs D CITY, STATE, ZIP FAX lvA C ,u� ;- ,,�` W OWNER ❑ OWNERBUBAER ❑ OWNER AGENT '18 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVMZPER ❑ TENANT CONTRA AMI / N I4 v ( GLICENSE NUMBER LICENSE TYPE 13 BUS. LIC tFj/ 0 COMPANY NAME S k oor1N ' Oeq^ Y" V io B-Mn{L ._haw t -au -@ Aotma I. cam FAX 650-- STREET ADDRESS 99 oeaa 00&tr RogD 2fSAKI CITY, STATE, ZIP C,4AWS070 PHONE 6,-50•-2 9 v- 09.-y ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 4 is , 'rite iaxjSr/rq4 BArrttgoom &kp K1-rctfcEN,6Zr- g zuiAi Dot -.5' . ZPc/}G - Uen 431t4 iT w /N R£ LAc-0E Zi—EC rA 1 C-44. EL GOii21N C7. EXISTINGUSE`� PROPOSED USE CONSTR TYPE # STORIES S F 11V 1 5 T J V Iii 01%(c USE TYPE OCC. SQ,FT. VALUATION (S) EXISTG I NEW FLOOR DEMO TOTAL AREA .Jf s� V AREA 0 AREA U NETARE Sir BATHROOM KITCHEN OTHER REMODEL AREA1/6 S in REMO DRLARBA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCII AREA GARAGEAREA: ODETACH I ATTACH ATT I # DWELLING UNITS: 1SASRCONDUNIT ❑YES SECOND STORY t4 C, BEINGADDrD? OJ06 ADDITION? ®-lib' PRE -APPLICATION El YES " IF YES, PROVIDE COPY OF PLANNING APPL # DJiC6 PLANNING APPROVAL LETTER IS THE BLDG AN El YEA EICHLER HOME? [E-440 $ VED T LVALUATION: By my signature below, I certify to each of the following: I Fun the.property owner or authorized agent to act on the property owner's behal . I hav read this application and the information I have provided is correct I have read the Desctiption of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rclathtg to wilding eonstructionn. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicaHl/Agent: G A-.,Vat,.t.�¢- N:.1 . 64AA�4—Z Date: AIA v z f) l SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-rn&COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building pelnnit for new building. -❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE. - FIRE DEPT _ Copy of Planning Approval Letter or Meeting With Planning prior to �j, r r submittal of Building Permit application. ❑ MAJ R G SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 SHEET 1 of 3 sheets . . Arnold Hom 05/03/17 05/03/17 B-2017-0682 Abby Ayende 10 8 15 14 SHEET 2 of 3 sheets Arnold Hom 05/03/17 SHEET 3 of 3 sheets . . Arnold Hom 05/03/17