The URL can be used to link to this page

B-2016-1488 i CITY OF CUPERTINO BUILDING PERMI BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1488 11052 FIRETHORNE DR CUPERTINO,CA 95014-0444(323 44 006) (BROTHERS HOME IMPROVEMENT INC) ROCKLIN,CA 95765 OWNER'S NAME: ELLIMAN ROBERT RAND MAUREEN DATE ISSUED:03/08/2016 OWNER'S PHONE:4084977843 PHiNE NO:8006723777 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 13,C17 Lic.409009 Contractor(BROTHERS HOME IMPROVEMENT INC).Date 3/8/2016 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing — MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my f license is in full force and effect. JOB DESCRIPTION: REPLACE 2 PATIO DOORS,AND 4 WINDOWS(MUST MEET EGRESS) I hereby affirm under penalty of perjury one of the following two declarations: -NO STRUCTURAL CHANGES 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. Sq.Ft Floor Area: Valiation:$6290.00 APPLICANT RTIFI ATION certify that I have read this application and state that the above information is correct.I agree to comply with all city and county APN Number: Occupancy Type: ordinances and state laws relating to building construction,and hereby 323 44 006 authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keeps harmless the City of Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code,Section 9.118. i Issued by:PAUL O SULLIVAN Signature _ Date /3 8/2016 Date:3/8/2016 WNER-B E LARA RF.-ROOF: i I hereby affirm that 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 two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole I inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature ofApplicanti 2. I,as owner of the property,am exclusively contracting with licensed Date:3/8/2016 contractors to construct the project(Sec.7044,Business&Professions Code). j 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 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 2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&SafetyiCode,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,shouldlI use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance withlthe Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the.Health;&Safety Code,Secdti s 25505 ,and 25534. 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 Owner or authorized agent: be deemed revoked. Date:3/8/2016 APPLICANT CERTIFICATION CONST R V NDING AGENCY I certify that 1 have read this application and state that the above information is 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 the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City 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 ARCHITECT'S DECLARATION understands and will comply with all non-point source regulations per the I understand my plans shall be:used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 31812016 i - CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 buiiding(ED-cupertino:org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED 6RIGINAL PERMIT# PROJECT ADDRESSD y r2 e- I _ APN 91 ORT ER NAME !q 1�V I PHONE f1(! L / ( E-MAILV STREET ADDRESS J y ,e.``,�/� 7 �8 0 S-z ''X✓WSL'V CITY.STATE.ZIP �J / ! , I FAX PHONE �7� % 0E-MAILCONTACT NAME E- ( / STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OOWyNtRAGENr ❑ CONTRACTOR. CONI CTORAGENT ❑ ARCHITECT E3 ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME /AkA% � LICENSE NUMBER LICENSE SE TYPE BUS.LTC I A COMPANY NAME (� E-MAIL /,. FAX !r ((�j STREET ADDRESS Al CITY,STATE,ZIP PHONE �� (�J rT/FIi 7v ARCHITECTBNGINEER NAME LICENSE NLt 4BER BUS.LIC# i COMPANY NAME E-MAIL i FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCR,'9TION 0F'.,'0RK 7N,91 I)Wle, IW�Te- EXISTINGUSE --PROPOSED USE CONSTRTYPE ;=STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG I NEW FLOOR DEMO TOTAL { AREA AREA AREA NET AREA BATHROOM - - KITCHEN - OTHER' - REMODEL AREA REhIODEL AREA REMODEL AREA PORCH AREA DECK AREA --[TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH -[]ATTACH 9 DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES - BELN.GADDED? []NO -ADDITION?? []NO PRE-APPLSCATION []YES ffYES,PROVIDE COPY OF IS THE BLDG AN ❑.YES .Et TOTALVALUATION: ,PLANNING APPL 9 ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO 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 7ding co - ction. I authorize representatives of Cupertino to enter the above-identifie property for inspection purposes. Signature of Applicant/Agent: Z Date: 371114,0 SUPPLEME AL N REQUIRED �T� ��_ � Roirrrncsr u New SFD or Multifami y Wellings: Apply for demolition permit for U existing building(s). Demolition permit is required prior to issuance of building NTE_,R BLIILDIT�GP.>A REYIE�Fy _ = permit for new building. - P g• zD�XPRES �.:PIAIv_'L'�G� _AlYREYlEF - _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure '" >4 g P farm if any Hazardous Materials are being used as part of this project. ,.L" "f,�. O...• _ DEPTH —Copy of Planning Approval Letter or Meeting with Planning prior to 3 =SAl\'ITARYE3SERDTSTRTCT submittal of Building Permit application. n„;�- :"� �v C -.� ��E1�TVlI20Rfi'fENTAL="FTEALTPI BldgApp 2011.doc revised 06121111 6,t.I h W &1,?,0W5 7'u e&9--445rs P KED BY ��c�� n� `�� rLcz ATE / 19�j7, Pool PLANNING DEPT Z 7 CUPERTINO CUPERTI O OFFFLGE COPY !dingMol-14 Depart gent A"w TIA�;R 0 8 201 4 �o C&MMU, �t REVIEWED FOR CODE C Wl�E NlTY Of' .IEN T � F?ART",-LENT BUILDIN,— I ON - CUs'ERTINO Reviewed By: T4SS'' i� APPROVED T;s set nf be kept at the jcb Site d ru :g c:r;tr,iction. it Is ur.l:1Af, l to make any changes or -�jterations on sante, or to deviate there'rorn, aproval from the Building Official. The Stariping ;, ;, p,an and -,Peci`C;Ions SHALL NOT be �er�:�t or to be an apprcval of the violation of a.; , . f any it' Ordinance or State Law. DATE PERMIT# S ,CE' � ,D BY C1o52 Fr�a�^'� '�' f'j�� TIIZ� Z`� ��a �!�►�— z _s