B-2017-2161 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO:B-2017-2161
22555 CRISTO REY DR CUPERTINO,CA 95014(342 63 005) STEPHEN CIARI
PLUMBING AND
HEATING INC
SAN JOSE,CA 95126
OWNER'S NAME. ROMAN CATHOLIC BISHOP OF SAN JOSE DATE ISSUED. 12/15/2017
OWNER'S PHONE.650-428-3730 PHONE NO:(408)296-6010
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class c-20,c36 Lic.#828351
Contractor STEPHEN CIARI PLUMBING AND HEATING INC Date 12/31/2019 X BLDG _ELECT X PLUMB
MECH_RESIDENTIAL X 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
NEW(2)2"POLYETHYLENE GAS LINES TO PG&E METERS 2
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
(mpensation,
as provided for by Section 3700 of the Labor Code,for the
formance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
ction 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation.$20000.00
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 342 63 005 A(Tenant Improvements)
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 against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino u cipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION
/7 ' illislz®Ii
Signature I 1 1 Date'Tf)/45/201-7 Issued by Jasmine Archbold
•
Date: 12/15/2017
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 roofing 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: 10/15/2017
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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ 6.ny person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ections 25505,25 3 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall VI,'
be deemed revoked. O' wne)or authorized agent:~
APPLICANT CERTIFICATION Date.1461-131-2E
I certify that I have read this application and state that the above information is 12/i5/20i7 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.
Licensed
Signature Date 10/15/2017 Professional
CONSTRUCTION PERMIT APPLICATION
% ' / B
. i COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertino.org PEMIT#B- 10 1:1- -2.i(el
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. KMEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN F
ZZ.665 6g(5/6 c.Ece D2_ Las ALR5S IIVZ-f 3LZ ( ) ® 6S
OWNER NAME PHONE , E-MAIL
&)r o FfEAUE GE 01/45:r E (" (tps'oL Z:53 " 37 3O
STREET ADDRESS CITY,STATE,ZIP
'2•2-5 5S- C ii 3TO gEY be- LU 5 i.-Ta 5 r G A qt-i o Z
g.CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME r LICENSE NUMBER LICENSE TYPE
Pt_urikt3114. 4"FfgrrriNGi INC.
CIq�t ^6 2 `s� (-11{ t C20/ C3(t,
I STREET ADDRESS CITY,STATE,ZIP J / I
c1)56
CA
E-MAIL PHONE BUS.LIC n
I�nU c e�cxrrPf'ta I`�dae�l C c(C)- ib 1-E.d35Z'62
❑ARCHITECT 0 OWNER 0 OWNERAGEIT ❑CONTRACTORAGENI`❑ENGINEER❑DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP • PHONE
DESCRIPTON /�
PKoo I L 1 y
t.3 . G A5 L. 3 E t� 2) _ C c t,.-Ir.1 L --cpaL -
❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES.k TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING El YES EICHLER ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO ❑ NO 0 NO —
DWELLING SECOND DWELLING. ❑YES 0 ATTACHED 0 DETACHED OTHER
UNITS it UNIT ADDITON: 0 NO S F
POOLSI r❑FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO ' TOTAL-SF r _ - ------7
(RECEIVED BY: r TOTAL VAL-UATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval `�.. ..170 L.Ar1' �,p
RE-ROOF)EXISTING ROOF TYPE: ❑BUILT-UP ROOF 0 ASPHALT SHINGLES ID WOOD SHAKES D WOOD SHINGLES UTILE OTHER(SPECIFY) L
REMOVE/REPLACE 0 NO IF NO PLYWOOD 11112" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0 YES tt OF LAYERS THICKNESS Q 5/8" OTHER ❑OSB ❑CDX OTHER :12 A
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 not 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 information 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 ordinances and state laws relating to building construction. I authorize representatives of Cupertino to,
enter the above identified property for ins ction purposes. I cknowledge and authorize all information contained on this application form
to be made available for public record.• r
Signature of Applicant/Agent:-- �Date:� 1 1 /`�o'�
SUPPLEMENTAL INFORMATION REQUIRED �^
*New Sib/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 +R
BldgApp_2017.doc revised 08/01/17