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B-2016-1705 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO-B-2016-1705 19608 PRUNERIDGE AVE CUPERTINO,CA 95014(316 45 016) BAY CITIES PAINTING SAN JOSE,CA 95168 OWNER'S NAME: SFERS REAL EST CORP UU DATE ISSUED:04/06/2016 OWNER'S PHONE:408-873-9090 PHONE NO:(408)223-6950 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class_C-33 Lic.#913840 Contractor BAY CITIES PAINTING Date 04/30/2018 X BLDG —ELECT X 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 license is in full force and effect, ,TOB DESCRIPTION: UNIT 9107-REMOVE(E)TUB,WALL,DRYWALL DUE TO LEAK. I hereby affirm under penalty of perjury one of the following two declarations: INSTALL(I)DRYWALL,TUB AND FIBER GLASS WALLS, 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. 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: Valuation:$1200.00 APPLICANT CERTIFICATION 1 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 316 45 016 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 copse ence of the granting all this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applican unders ds an ill comply with all non-point source regulations per Cu ertino M ip Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION. (ISig atur,e Date 4/ /s 201f Issued by:Abby Avende Ag Date:04/06/2016 1 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:4/6/2016 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. 1 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 Bay Are u u . Management District I Worker's Compensation laws of California. If,after making this certificate of maintain compliance with the Cuper,�o Municip. Co ,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, t' ns 25505, 3 ,a d 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Da e:4/6/2016 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 1 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. 1 understand my plans shall be used as public records. Licensed Signature Date 4L612016 Professional CONSTRUCT[QN PERMIT APPL[CAT[QN x CONiMUN[TY DEVELOPMENT DEPARTMENT. BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255-' CUPERTINO (408) 777-322.8• FAX(408)777-3333•building(E,cupertino.org —11015 ❑l\TEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGhNAL PERM3T T PROJECT SS - DAYle 01AINTER NAME PHONE " � %b -10 E-A24IL zho A. STREET ADDRESS �(3 9 I CITY, STATE,ZIP r 5 FAX CONITACT NAME PHONE I E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑ o AN' ER ❑ M TER-BUILDER ❑ 0)VXERAGENT ❑ CONTRACTOR ❑CONTR4CTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENAKT `TRACTO '.4AiE � "'�I LICENSE. '1 SER l LICENSETYPE I BUS.LIC R COMPANY C/Ljyli /i �'�Iy E-? 4ILt/ ��1c FAX � < r 6 STREET. RES CITY,STATE,ZIP PHO'F Wig' 3 ARCHITECT/ENGLNEER NATE LICENSE NUTABER BUS.LIC' COMPANY NAME E-I MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF\FORTE kP1Yb0 Ue EXISTING USE PROPOSED USE CONSTR.TYPE 'STORIES USE I TYPE OCC. SQ.FT. V?.LLATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA; AREA AREA NET AREA .. BATHROOM/ - KITCHEN OTHER - - - - RE31\40DEL.AREA REMODEL AREA REMODEL AREA PORCH AREA DECK A REA TOTA?DECK•'PORCH AREA GARA.GE AREA- DETACH ❑ATTACH D\3%ELLiNG UK-ITS: IS A SECOND IINIT OYES SECOND STORY ❑YES BEL\GADDED? ❑NO ADDITION' ANO PRE-APPLICATION ❑YES IF'�.S.PROVIDE COPY OF IS THE BLDG AN ❑17F5 EI\ED BZin i TOT 4L VALUATION: PL.A\rNIhG.APPL' ❑NO PLANNING APPROVAL LETTER I EICHLER HOME. E]NO 21 �• „`r° By my signature below,I certify to each of the follot..-'ng: I ertv o jner or authorized agent t act o the property owner's behalf. I have read this application and the information I have provided� c e . I have rea e D cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lalvs relating to bu• ding Ion. I authorize resentatives of Cupertino to enter the above-e-ididentified property for inspection purposes. Signature of Applicant/Agent: - Date: STi PLEMENTAL INFOR-NiATION EQUIRED ION New SFD or Multifamily dwellings: Apply for demolition permit forTO OY ER TFE CDU\TER BLTILDI\G PZ 3\I2EY IEYY existing building(s). Demolition per-mit is required prior to issuance of builduig ti perinif for new building. I� E RESsT ConlrnercialBldgs: Provide a completed Hazardous Materials Disclosure sT�iDARD ?� T—. U7 a I' io=if any Hazardous 1\4aterials are b-,ing used as Dart Of tills project. •3� LARGE x a '`° � RED PT �� _Copy of Planning Approval Letter or Meeting with Planning prior to fg -Ld 7.1AaoR 5 O SA\ITAIt]SES ER DISTRICT submittal of BuiIdinQ Permit application. :i a — '� E\\"IRO\1iE:�T.4L HEALTH Bldg pp_2011.doc revised 06121111