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B-2017-1203CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1203 10169 EMPIRE AVE CUPERTINO, CA 95014-1204 (326 24 034) FOUR SEASONS CONSTRUCTION AND SERVICES SAN JOSE, CA 95122 OWNER'S NAME: BONETTI ROBERT J TRUSTEE DATE ISSUED: 07/24/2017 OWNER'S PHONE: 650-279-4728 PHONE NO: (408) 398-0814 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a. Lic. #991632 Contractor FOUR SEASONS CONSTRUCTION AND SERVICES Date X BLDG —ELECT —PLUMB — 03/31/2018 MECH X RESIDENTIAL — COMMERCIAL 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 JOB DESCRIPTION: license is in full force and effect. KITCHEN REMODEL (95 &F.); BATHROOM REMODEL (50' S.F.) REV #1 - REPLACE WINDOWS (5) LIKE FOR LIKE TO MEET I hereby affirm under penalty of perjury; one of the following two declarations: EGRESS; REPLACE DOOR (1) r. I bave'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 Sq. Ft Floor Area: Valuation: $32000.00 permit is issued. ,3 APEL.ICANT! CERTIFICATION certify that I have read this application; and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 32624 034 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue�against said City, in comsegbiince of the granting of this permit. Additionally, the applicant understandsl'and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertlgp.UUn1opffl Code, Section 9.18. li Issued by: Abby Ayende Signatu Date 08/08/2017 ,I Date: 07/24/2017 OWNER-BUILDER DECLARATION RF ROOFS: I hereby affirm th'a't I am exempt from'the Contractor's. License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following tworeasons installed without first obtaining an inspection, Ii agree to remove all new materials for 1. I,as owner of the property, or my employees with wages as their sole inspections compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) i Signature of Applicant: z. 1, las owner of the property, am exclusively contracting with licensed Date: 08/08/2017 i'l'. ';''I i, contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have for by and will maintain Worker's Compensation Insurance, as provided California Health &Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code,', for the performance of the work for which this 1'.i, maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous permit is issued. a. I certify'that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay AreaAir Quality Management District I shall not employ any person in'any manner so as to become subject to the Worker's' Compensation laws' oIf California. If,. after making this certificate of wiH maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 2 ,rmtd'25534. exemption, I become subject to the Worker's Compensation provisions of the Laborl Code, I must forthwith' comply with such provisions or this permit shall # ��00 Owner or authorized age bc,deemed revoked. Date: 08/08/2017 APPLICANT CERTIFICATION I certify that) I have read thisapplicati6h 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 of work's for which this permit is issued (Sec, 3097, Civ C.) relating to Building construction, and hereby authorize representatives of this city Lender's Name to enter upon;thelabove mentioned property for inspection purposes. (We) agree to save indemnify'and keep harmless the;Gity of Cupertino against liabilities, Lender's Address judgments;`costs,"and expenses which;may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 08/08/2017 Professional CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 REVISIO (408) 777-3228 • FAX (408) 777-3333 • building kupertino.org 1Y Vl ❑ 4 ADDITION [:1ALTERATION / TI VRFVISION / DE RRED IGIN PERMIT # PROJECT ADDRESS t v( Pi !-rt. lot APN # OWNER NAME c— �'� PHONE tLCOI ZTGi -; E-MAIL STREET ADDRESS #Z rlr (AS fft . CITY, STATE, ZIP 'Y1+V Nv, A. I IIuc_A_ _7 FAX NAME PHONE E-MAIL STREET ADDRESS, CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER , ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME StAr~ A v_ LICENSE NUMBER Q� �i 1 ` �! 2 ` 6 7 LICENSE TYPE 13 BUS. LIC # _I COMPANY NAME ^� �/ rS / _ _ ��. E-MAIL FAX STREET ADDRESS ��� 7 ., �i I• C1 CITY,STATE,ZIP � ` r0� /���- V PHON(4�—3clyV81 ,7 V ARCHITECT/ENGINEER NAME, LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA 'NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? NO ADDITION? ❑NO i PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY + "� ti �' �'' J TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO a �,�: '- = r �. �' . 03 too By my signature below, I certify to each of the following: I am the property owner or authorized agent to act 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 Work and verify it is accurate. I agree to comply iwith all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTUVG SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER` TEE COUNTER ❑ BUI11DWG PLAN REVIEW w existing building(s). Demolition permit is required prior to issuance of building , permit for new building. EAPREss f 1 ❑ PLANNING PLAN REVIEW + `sTANnaRD e" }t Y _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ' y ❑ rusiic woRxs ;r " fonn if any Hazardous Materials are being used as part of this project. 0LARGE �❑ _ Copy of Planning Approval Letter or Meeting with Planning prior to ;, FIRE DEPT' t= ❑ "b submittal of Building Permit application. MAJOR SANITARYSEWERDISTRICT , ;ENVIRONMENTALHEALTH . B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-1203 10169 EMPIRE AVE CUPERTINO, CA 95014-1204 (326 24 034) FOUR SEASONS CONSTRUCTION AND_ SERVICES SAN JOSE, CA 95122 OWNER'S NAME: BONETTI ROBERT J TRUSTEE I I DATE ISSUED: 07/24/2017 1 OWNER'S PHONE. 650-279-4728 License Class a Lie. #991832 Contractor FOUR SEASONS CONSTRUCTION AND SERVICES Date 03/31/2018 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: 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. L 22. 1 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 per the Cupertjpoi ode, Section 9.18. Date 7/24/2017 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) 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). PHONE NO: (408) 398-0814 BUILDING PERMIT INFO• X BLDG —ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION. KITCHEN REMODEL (95 S.F ); BATHROOM REMODEL (50 SY ) Sq. Ft Floor Area: I Valuation: $32000.00 APN Number- Occupancy Type: 326 24 034 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by, Abby Aye -n-& 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 ofApplicant: Date: 7/24/2017 I hereby affirm under penalty of perjury one of the following three declarations:I ALL 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. 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. 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 7/24/2017 TO BE CLASS "A" 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, Cha t 9.12 and the Health & Safety Code, Sections 255 , . 25534. Owner or authorized agent: Date: 7/2412017 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 Professional Ci P15RTINa El NEW CONSTRUCTION °D-ZOR- CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (408) 777-3333 • buildingacupertino.org El ADDITION ALTERATION / TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS l 01, tt �• LY 1 _ } �' 1 �, APN # �% _ 214- � OWNERNAIIE• lcoovI TO 6 i 1 — 4� L PHONE t 7 .2, STREET ADDRESS ZC C�� S I. , CITY, STATE, ZIP I� m �� re Vt � l�'� ]IE FAX CONTACT NAME 'Yy lY 10 <4T y; PHONE MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER. ❑ OWNER -BUILDER 0 OWNER.AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME S+IN ! A QQ LICENSE NUMBER C' Cr ` 6 3 Z LICENSE TYPE � BUS. LIC # %V COMPANYNAMH Fovyy $Lon-upt5 Cn1kIr. E -MATT. fWAV SJr 014J,G. rh (% 0 y"�l0 FAX STREET ADDRESS 2136 TWIt tl,ot. 4 1014 CITY, STATE, ZIP Swy, TO JC Ch � V1,22 PHONE C40j 3riywv��tt ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ` K4awn rvm d4t ( rA y 14AX c-d� V -s I a ape 6w ca•& r cD to q by �* ( -s;v) ks vitt/ $a V11 rvm VOL" 1 -e ft I w CA of b luras+ '1 h► b/ S kw,—fhr �6y I-ey c S., +-b 4A- 1 11164 EXISTING USE PROPOSED USE - CONSTR. TYPE I # STORIES USE. TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA. NET AREA - " BATHROOM REMODELAREA 7©f KITCHEN a AREA "iSf�"�' OTHER - REMODELAREA -PORCH'AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGEAREA: DETACH ❑ ATTACH - < # DWELLING UNITS: - IS A SECOND UNIT ❑ YES SECOND STORY - DYES " B£INGADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF PLANNINGAPPL# PLANNING APPROVAL LETTER Is THE BLDG AN [I YES EICHLERHOMET ]NO..,s�3 i MFM ED=BY -- ' �r r 7 `''' �' w �jTOTAL VALUATION: []NO .7 Z By my signature below, I certify to each of the following: I am the propertyowner or authorized agent tb act on b3e property owner's behalf. I have read this application and the information I have provided is correct. I have read Description of Work and verify it is accurate, I agree to comply with all applicable local ordinances and state laws relating to building cons onze representatives of Cupertino to enter the above -identified property for inspection: purposes. Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED r���otriarc ski New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building r �� permit for new building. Bldgs: Provide completed Hazardous Materials Disclosure C7 snRD� Pic sl7eo� �: _ Commercial a z '- form if anHazardous Materials are beim used as art of this ro ect.g�� y g p 1' J Copy of Planning Approval Letter or Meaffig with Planning prior to _ CIoR sANrrnRsEwERRVISTRICT submittal of Building Permit application. BtdgApp 2011.doc revised 06121111 Abby Ayende 07/25/17 07/25/17 B-2017-1203 Abby Ayende Abby Ayende 07/25/17