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B-2017-1626 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1626 7515 BOLLINGER RD CUPERTINO,CA 95014-4332(359 23 029) ANTHONY HODDER CONST CUPERTINO,CA 95014 OWNER'S NAME: DEGUARA CHARLES AND LOUISE M TRUSTEE DATE ISSUED:09/20/2017 • OWNER'S PHONE:408-257-6305 PHONE NO:(408)499-5990 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#446573 Contractor ANTHONY HODDER CONST Date 06/30/2018 X BLDG _ELECT _PLUMB 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 license is in full force and effect. JOB DESCRIPTION: 1ST FLOOR MASTER BEDROOM AND HALLWAY BATHROOM I hereby affirm under penalty of perjury one of the following two declarations: REMODEL(80 S.F) 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 erformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance,as provided for by /13 Sectio '700 of tht!Labor Code,for the performance of the work for which this p '-'- l's'e' Sq.Ft Floor Area: Valuation:$15000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 359 23 029 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 ag-'nst said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT;ISSUANCE OR Additionally,t e-pplicant understands and will comply with all non-point source regal-tio,s percttae-C:potino Municipal ,ode Section 9.18. -180 DAYS FROM LAST CALLED INSPECTION. r nater- Ll r /4.4/..4- e •r",3,E0 Issued by:Abby Ayende - Date:09/20/2017 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 roofmg material being installed.If a roof is 1. 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:9/20/2017 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 3. 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 Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with tCiertino. nicipal Code,Chap 9 2 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety odeSe tions( , y�15,25533,and 25 4. Labor Code,I must forthwith comply with such provisions or this permit shall v v G be deemed revoked. ner or authorized age • APPLICANT CERTIFICATION Date:9/20/2017 I certify that I have read this application and state that the above information is CONSTRUCTION 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. I understand my plans shall be used as public records. Signature Date 9/20/2017 Licensed Professional CONSTRUCTION PERMIT APPLICATION �> • COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 7. P9 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 45-c.t9,.,, (408) 777-3228 • building@cupertino.org PEMIT#B- °�� - 1�@` '`P CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITIONAD ❑ALTERATION ❑T.I. ❑MEP 0 RE-ROOF ❑SWIMMING POOL/SPA • PROJECT ADDREeS� /� ` �� APN# G� 2.3 - o 2G� OWN E ( �t �. Pe6-- Un-i403-as� '\Y✓OC E-MAIL ' STRcETIC' 'D1:2$eCITY, ATE,ZIP ‘ 7375- �,P0G- g rd© . ❑CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE C. . <H9—c(2-c,- �-, (6 t s �� 73 • - , STREET ADDRESS - ( STATE,ZIP / I I L 6— E-MAIL PHONE C' '/ BUS.LIC# 0 ARCHITECT ❑OWNER 0 OWNER AGENT ❑CONTRACTOR AGENT 0 ENGINEER❑DEVELOPER 0 TENANT . CONTA NA E-MAIL • STREET ADDRESS CITY,STATE,ZIP PHONE DECRWTON • ❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL • I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED EXISING ❑YES EICHLER ❑'YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS❑NO 0 NO 0 NO DWELLING SECOND DWELLING ❑YES ❑ATTACHED 0 DETACHED OTHER UNITS# UNIT ADDITON: 0 NO S F POOLS' ,❑FIBERGLASS 0 VINYL-LINED ❑GUNITE ❑PREFABRICATED POOL-SF ' . SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF RECF,.IVED BY: T AI�VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval 1 jV�/�' Q/voU I i([�Sl'1 RE-ROOF'EXISTING ROOF TYPE: 1=I BUILT-UP ROOF ElI ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES II] L TILE V vOyTHER(SPECIFY) . REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'�" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS El YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER .12 A i PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES 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 informa s o I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local or.' : c:s and stat- laws relating to b 'ding construction. I authorize representatives of Cupertino to enter the above-identified property for'i p:ctio .:es. I acknowle 'e d orize all information contained on this application form n to be made available for public reco . 7 Psi ^ rJ^ (-7 Signature of Applicant/Agent: Date: L-C/ SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owner's Association BldgApp 2017.doc revised 08/01/17 Abby Ayende 09/20/17 09/20/17 B-2017-1626 Abby Ayende