The URL can be used to link to this page

B-2016-2506CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2506 19479 ROSEMARIE PL APT 2 CUPERTINO, CA 95014-3452 (375 01 007) OWNER -BUILDER 19479 ROSEMARIE PL CUPERTINO CA 95014-3452 OWNER'S NAME: COHEN DAVID N ET AL DATE ISSUED: 08/15/2016 OWNER'S PHONE: (6500766-9160 PHONE NO: None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER -BUILDER Date R BLDG X 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 license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE SUB PANEL (100 AMP);SAME LOCATION (UNIT 2) 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: Valuation: $2000.00 APPLICANT CERTIFICATION 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 375 01 007 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. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 08/15/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of theproperty, or my employees with wages as their sole. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. a. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of 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 be deemed revoked. r 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granti of this permit. Additionally, the applicant understands and will comply with all n -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 08/15/2016 Issued by: Kim Dunbar Date: 08/15/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofAppl Date: 08/15/2016 BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I useequipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and the Health && Safety Code, See' s 25505, 25533, and 25534. Owner or authorized agent: / Date: 08/15/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed rumGENERAL PERMIT APPLICATION C0WjMiUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION M E 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 =k (408) 777-3228 - FAX (408) 777-3333 - buildingaguDerting.org CUPERTINO- 13' 2,0 1 zY,61 S [I PLT,12,413D�G E1mEaLkNjc.,.L Fyt'FT -ECTRICAL F7 1\41 SC'PT T A V -r" IC. PROJECTA.DDRESS )ON7-12� APNE, 0 OWNER NA.%E C,o 6�v-, Delt'd "I' AR (mr�- PHO117E E- �'m 61C d19 b m casfi STREET.A.DDREESS CITY", STATE, ZIP Lftaa- FAX CONTACT NAIMEeo 'e'r M, E-MAIL 421-t - H) I R) STREETADDRESS 236 rh e-. CITY, STATE, ZIP(f q5 00-3 FAX E3 OVnitEl o -BUILDER OVI-FRAGENT 11 CO`,T-PL/,CTJOR E3 co,,�TR., ma.,,GmhT [] APC. -'F -=CT 13 ❑DEVELOM El T,'.'.A2,:T CON--R.4,CTORX-AJ,-,E 'r* LICENSE WGERg6 3 g Z t l LICzNSzTYPE i� Bu, S. LIC T c02"P-A-"-YLi 4 ha" h 0- A(tkv-�; FAX S —IREET A DDRES SCITY, 790 0 IoS Au..IJ I � L) STATE, ZIPS.:;;L 1 � PHOI\E 65-0 V11% -4 0 ARC',DTFCT,IE.\'-GNEk--Rl\.—I,SE I LICEN'SE 1,RWMER BUS. LIC -4- COMP ANYNAME I E-1,iAIL FAX STREETADDRESSCITY, STATE, ZIP I PHONE USE OF El SFD,DT--.PLEX ❑ MULTI -FAMILY PROJECT I]N-'W1LDLA-\T 0 -ns PROJECT IN ❑ YES IS TIM BLDG AN El %is BUILDN-0: [] Com", =-CI.A.L N7ERF4CEAREA El 0 FLOOD ZONE El No EICHLZRHOME? El -N-O DESCRIPTION OF'9,;OPX 50j-AAr (-V/ too Code- TOTAL VAL UATION: 0 RFC I\ E Y. *2 00 . .... of By my signature belovvI certif}, to each o 'e I ainThee propert), owner or authori;zed,agnt to act on the property owner's behalf lhaveTead,zhis "EX-rect. application and &e infornoation I have -or .0 I have read the Description cflYork and ve.6-JR, it is accurate. I a---.-. to counply,,vith all applicable local gad state laws relating to b�, bovC-1 C13LID,dl roper Ordinances a �cC6111. I authorize representatives of Cupertino to enter the a 'd er[ , for inspection purposes. �ilding/'consm A Si -nature ofApplicant'kgent: f Date: S5PLtl\!ENTzk&r'\;FORn4ATIO-'\T REQUIRED OFFICE E -W\ P V 7� ;t4OR� MERM17s-cZ-.p.p_201J.doc revised 06121111 mar i r;ppwt n p ter i l i �. � � p, mitt d. ire r r it tielf 05 the Idor of ttio, property imp rove M OftsperJfj od" t X0471 , ;a6 i priir r . , 0. '- ADDRESSoh rtThl Fairfax an on OwneT�aWdef A01' lowled1b ant. and Information. v € r a it iii r you (noy in r i1, vi t i perm a err s �. a lider. We rtt rtot 4 wilding permit until YOU MV0 rbAd Wti i ra _ "signedand tar, . 'FIs r -MIO " t r oW, t dpi i � "" . M "p .f tom. =O,o r q thjg no sa�i��. :gag thee per, i tie prr pprvof the P"hitting autodnty CONSTRUCTION', LeNDIN. NC (DIRECTIOW, COMPI-00 ria fol construction lenrAitg Vqnyiht a . 1 here0y elan that More is, 8 ponstoiction landing eency for Of the. work for Which this Parmit.1 it .c 3097, t. Lender'3;- Ladder Addr't (NOTE.',,:..I - fbil(iW?tr 4z %�' to J1z �a �r ra tied r�.r t, lr rrfr r a=Bullde re . ...... ..... ........ Maw € in theonce -€o Pn*erty Owner, Ithe;bxet-upion 6f which i Understand € personal raspoititlill,hereby Qwner-,Buildiar Perrriftfor tragi project Kitchen r n€€orisr : � € � � t es. Scope ` ConstrUction Proj t dor DescriWbon of l r): . 19479, Rosennadee i CA 95014 NaMe Obert V'x-824, ti t rpt: Tel No Addressdl sutb rfAgent, 31,31 Ascom Ave. #230, Cam , C 95008 . , 3exPar under pahaltyof perjuthat owner for "the ni,ally l€antthe Worn €lorl and Certifyf accuracy, We,, A copyof the property owner'; dr, Ws.ffbeas, form notarizotiorl, or otner, verification w.f t r tt rf� , t� presented when th � �ti issued t . r�� f tqr rr Z A .✓ Propel wn r' -sign t � a � � � � � � n� �� -� `