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B-2016-2227 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2227 22035 CREEKSIDE CT CUPERTINO,CA 95014-1103(326 39 040) HOWARD LAMCKE CAMPBELL,CA 95008 OWNER'S NAME COCHRUM LISA ATRUSTEE DATE ISSUED:06/29/2016 OWNER'S PHONE:408-781-5624 PHONE NO:(408)377-7001 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#420903 X_BLDG _ELECT _PLUMB Contractor HOWARD LAMCKE Date 03/31/2017 _ 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. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: GARAGE REMODEL(400 S.F.)-ADDING SHEI TROCK 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. X/k //FI 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:$5000.00 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 326 39 040 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 Municipal Code,section 9.18. 1$0 DAYS FROM LAST CALLED INSPECTION. ,S�ilgnLure 124 Date /6 29/2016 Issued by:ABBY AYENDE Date:06/29/2016 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 r move 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) z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/29/2016 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. I will permit is issued, maintain compliance with the Cupertino Municipal C de,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 de ces which emit hazardous air contaminants as defined by the Bay Area Air Qual ity Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municip d Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,15533,and 25534.. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. %Owner or authorized agent APPLICANT CERTIFICATION Date:6/29/2016 certify that I have read this application and state that the above information is CONSTRUCTION LENDINGA ENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending ac ency 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' DE ARcor N u Code,Section 9.18_ i understand my plans shall be used as public records. Licensed Signature Date 6/29/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT^BUILDING DIVISION 10300 TORRE AVENUE-'CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildin cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ' TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 2�3 Coze&� c� EN:# �/ „ ' r L 1. rJ �% U OWNERNAME L}�gry IAC h/(//"` PHONE`°7tP7'/Sr��q E-MAIL Li r COC4%eV1 ShL f��9�jw6 i,Ae STREET ADDRESS �� Cr.e j P o r CITY, STATE,ZIP v '/)`,D /1 FAX - CONTACT NAME �F PHONE /JAW E-MAIL E-MA STREET ADDRESS W CITY,STATE,ZIP FAX ❑OWNER 0 OWNER-BUILDER ❑ OWNERAGENT O CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑:TENANT CONTRACTOR NAME � � �QC LICENSENUMBER LICENSE TYPE BUS.LIC# COMPANY NAME EMA�T � WAsv� LA G1G( SY/�y!✓"n7r FAX STREET ADDRESS,r- pP�v Ch 'L CITY,STATE,ZIP CF_p�eG /f� q 5'' PHONE Cf v ARCHITECT/ENGINEER NAME LICENSE NUMBF,R v BUS,LIC# COMPANY NAME- E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION aFwoRx � ge 1 54,eiror-L, �r�� o, �Z ®�! 460 A 17t EXISTING USE - PROPOSED USE CONSTR.TYFE #STORIES USE TYPE OCC. SQ.FT. ALUATION($) EXISTG T-NEW FLOOR `TDEMO TOTAL �•-[ AREA AREA AREA NET AREA. a 5t `l®� O CO BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA. C400,54- PORCH q 0Q,54_PORCH AREA DECKAREA TOTAL DECK/PORCH AREA I GARAGEAREA: FIDETACH - 9 ❑ATTACH DWELLING UNITS: ISASECONDUNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? E]NO PRE-APPLICATION El YES IF YES,PROVIDE COPY OF IS THE BLDG.AN E]YES REOEIUE 77 : TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO , = By my signature below,I certify to each of the following: I am the property owner or authorized a•ent t ct on the property owner's behalf. I have re d 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 app icable local ordinances and state laws relating to building contra tion. I authorize representatives of Cupertino to enter the above-identified property for inspectio purposes. Signature of Applicant/Agent: M Date: ® a0` 71 SUPPLEMENTAL DZ11FORMATION REQUIRED rLnivcHcx� P % „ zzovraN 'stir New SFD or Multifamily dwellings: Apply for demolition permit for ' OVER THE-COuNTEIt DUiLDING PLAN ,VI existing building(s). Demolition permit is required prior to issuance of building ., permit fox new building. 'IXPRESS' C1. Pi> ING;1?W xENnEw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARTI ❑ P arae woxxs v " form if any Hazardous Materials are being used as part of this project. Q='LARGE '<i r ❑ FIRE iEPT Copy of Planning Approval Letter or Meeting with Planning prior to ,MAJox D SA viTARY'sEw R DISTRICT submittal of Building Permit application. v,. :_ © ENVIRbJ\ NT BZdgApp 2011.doc revised 06/21/11