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B-2017-0299CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0299 21667 ROSARIO AVE CUPERTINO, CA 950144758 (356 19 039) SIERRA STRUCTURE MEADOW VISTA, CA 95722 OWNER'S NAME: WELCH PAUL MAND JANE DATE ISSUED: 02/23/2017 OWNER'S PHONE: 408-857-2515 PHONE NO: (530) 878-0365 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lie. #778626 Contractor SIERRA STRUCTURE Date 11130/2018 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 license is in full force and effect. JOB DESCRIPTION: REMODEL KITCHEN (230 S.F.); REMODEL HALL BATH (50 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: m. I have and will maintain a certificate of consent to self -insure for Worker's REV# 1 -REMODEL LIVING ROOM (250 S.F.); CHANGE DOOR - Compensation, as provided for by Section 3700 of the Labor Code, for the ISSUED 3/31/2017 - 1perfommance of the work for which this permit is issued. 2: I have and will maintain Worker's Compensation Insurance, as provided for by MSection 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $75000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 356 19 039 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. Additionally, the applicant un Stands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the pertlno Municipal Code, Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 3/31/2017 Issued by: ABBY AYENDE . Zt;�ARATION Date: 02/23/2017 RE -ROOFS: OVIINER-RTAT I hereby ai'firm that I.am exempt from the Contractor's License Law for one of the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is m. 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 (Scc.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: 3/31/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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 25M(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 Area Air uality Management District I Worker's Compensation laws of California. If, after making this certificate of �.� maintain compliance with the Cupertino tcipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Se 05, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION (bate: 313112017 I certify that I have read this application and state that the above information is CONSTRUeYION LENDINGAGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this p rmit 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. Signature Date 3/31/2017 Licensed Professional CUP RTINO NEW CONSTRUC' CONSTRUCTION .PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3.333 a buildingacupertino.org CION ADDITION _ _ � ALTERATION / TI , REVISIO %DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS OWNERNAME ( � f^ PHONE / E-NIAIL STREET ADDRESS E i j CITY, STATE, P U' -JT- s j FAX CONTACT NAME PHONE ljL� E-MAIL "7-# 11.71 Ro 60141Z. STREET ADDRESS . ¢ FAX ❑ OWNER ❑ OWNER-BUnDER �❑ OWNERAGENT ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME \/� LICENSE -ByE9R 62 / LICENSE TYPE BUS. LIC # COMPANY NAME i E-MAIL FAX STREET ADDRESS L \ CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-l4AIL FAX .�_. STREET ADDRESS `� t CrfY STATE, ZIP PHONE TO !l .-- �z�s..s„A..,,•�.�.��. _ .dam. DESCRIPTION OF CORK % i/ ,,r j OL"T eon✓ G� EXISTING USE P POSID USE COA]STR TYPE # STO S ! USE TYPE OCC. SQ.F7'. VALIiATION-T ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGEAREA: DETACH - I ATTACH I # DWELLING UNITS: IS A SECOND UNIT [LYES SECOND STORY ❑ YES " BEING ADDED? []NO ADDITION? []NO ' PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # I❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES ❑ NO - RECEIVED BY' TOTAL VALIJATiON: By my signature below, I certify to each of the fa ing: e p perty owner or authorized agent t act on the property owner's behalf. I have read this application and -the information I have provide is torr 0111 aver d.the`Descrip@on of Work and verifyit is accurate. I agree to comply with all applicable local ordinances and state laws relating to building'co n. I an rize representatives of Cupertino to enter the above -id e fled pr perty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL ORMATION REQUIRED PLAN CHECK TYPE ROUTING sire OVEI%THE COUNTER _ © BUH DrNG PLAN REVIEW New SFD or Multifamily flings: Apply for demolition permit for[( existing building(s). Demolition permit is required prior to issuance of building permit for new building. 0 EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD PUBLIC WORKS form if any Hazardous Materials- are being used as part of this project - 0 LARGE ❑FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MAaoR © SANITARY SEWER DISTRICT submittal of Building Permit application. Q ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0299 21667 ROSARIO AVE CUPERTINO, CA 95014-4758 (356 19 039) SIERRA STRUCTURE MEADOW VISTA, CA 95722 OWNER'S NAME: WELCH PAUL M AND JANE DATE ISSUED: 02/23/2017 OWNER'S PHONE: 408-857-2515 PHONE NO: (530) 878-0365 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #7 8626 Contractor SIERRA STRUCTURE Date 11/30/2018 X_ BLDG _ELECT _PLUMB MECH X RESIDENTIAL 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: REMODEL KITCHEN (230 S.F.); REMODEL HALL BATH (50 S.F.) 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 Compensation, as provided for by Section 3700 of the Labor Code, for the of the work for which this permit is issued. z�erformance have and will maintain Worker's Compensation Insurance, as provided for by P`�'-' Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $75000.00 permit is issued. 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 356 19 039 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 con quence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant unde n and will comply with all non -point source regulations per thef ino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 02/23/2017 Issued by: OWNER IM RDECLARATI Date: 02/23/2 17 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 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) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 02/23/2017 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 sclf-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 z. 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. s. 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 any manner so as to become subject t shall not employ any person the air contaminants as defined by the Bay Area uality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cuperti 'cipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Se 5505, 25533, 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: 02/23/2017 `- certify that I have read this application and state that the above information is N TI LENDING AGENCY 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 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, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 02/23/2017 Professional GONSTRUCTICN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION BERM 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPER T €Nd (408) 777-3228 • FAX (408") 777-3333 • building a5cuoertino.org �? v 20 / 9 e ` / II \TF«7 rnh.(Z'FP T V'T1r) T F7 ^ nT')TTTf1TT 17 IT ^rT-1 . -—IT : T, F7 � -- - — I..J ' LLl LS�.R [,L V1lllJ1�V L YFI(I\SII I ,* BCT .ADDRESS t �� / v e- e I A3N PROpp pp OZV'\ERNfi T E PHONE E7?,MAIL AV f e �G E/05 -'95-7-22,515 STREETADDRESS �\ l CITY, STATE, ZIP I FAX CONTACT NAMET PHO\ -E &MAIL STREET ADDRESS V CITY , STATE, Z FX s �€ 1 YID �o VIA �•� 62 _ _3 fAD - S-2 7 - C13 b Wo v �✓.4 r rd OWNER ' ❑ Oq -BLED R OWINTERAGENT ❑ C01 IP ACTOR ❑ COITRACTORAGEI.T 0 AR=- ECT ❑ ENGINEER ❑ DEIBLOPER ❑ EN,,,N • CON P.ACTORNAA4E L]CE SE 1 BFyR�1 LICENSE E ((E-Aa}IL((�' BUS. LIC Lf V - �7 _3'�J I' CON3PANYNA-74E l�Av�r�C211 c rus FAX rc a kvl.4o 53D-9 9 636j— STREETADDRESS ` [ t C! TY, STATE, ZIP PHONE ARCHITECT,E\GLS-EER NAN4E I LICENSE NZ�„BER BUS. LIC CONiiPA\Y N.ANiE — E-M)UL FAX STRF-ET ADDRESS CITY, STATE, ZIP I PHONE DESCP.IPTIOIi OF 1VORK EXISTII.G USE' - ( PROPOSED USE CONSTR. FYPE= STORIES USE TYPE OCC. - SQ.F'T, - V'ALUAT'ION (S) EXISTG NEN' FLOOR DEN40 TOTAL-`----'- APEA AREA AREA NSTARFA BATHP.00N4 REI.40D'cLAR.EA 5o IG.TCHEN REMODELARPr9•) o OTHER RE1,40DELAP.EA PORCH AREA ” I DECK A-RE.A TOTAL DECK PORCH AREA GAR AGE AREA: [j DETACH ❑ ATTACH D'WELLING LNITS: _ IS A SECOI\D.U:'tIT ❑ YES SECOND STORY []YES. BELNG.IDDED? E] NO .kDDITION? ❑NO i PRE -+,?PLIC -=.TIO?:' ❑ -YBS IF YES, PROVIDE COPY OF IS THE BLDG AN �" " " " "" " " - -" ❑1'ES Y;;;:`= :, ` TOTALVALU_ATION PL_e\NL\GAPPL-_ []NO PIJ'-\NGAPPROVALLE17E_R I EICHLERHOASE? ❑ By my signature below, I certify to each of the following: I ain the property owner or authorized agent to ae property ov ner`s behalf. I have ,-ead this application and the information I have provided is correct. I e rea the Description of "WOTI, and VeijtPIT is accurate. I agree to comply with all applicable local ordinances and state laws relating to builds _ " structs autho '" e representztives of Cupeitino to enter the above --identified property for inspection purposes. SianatureofApplicantiAgent: `/>� Date: of `3 717 SUPPLEi\ZET�"L INFOR\4ATION REQUIRED .::.PLA -Ti CHECiiTIPE. ;". _� t � •- _r ROL'I'LK"- . G. SLIP. 0\ ER THE COU'�TER - BLiLDING PLA_'\"REVIEW � 1\ New SFD or ?l -Multifamily e1lings. App.} for demolition permit for bullding(s). Demolition exisnnz permit Is required prior to Issuance of building pernTltfor new bulldmQ•.:PRESS•°=. - ,__.::,.......:..,...:;:>; PP=A�-K LNGPLAN RE\TESVSn' r`:;: Commercial Bldgs: Provide a completed Hazardous Materials DiaCIO.L.H D:=.zSTA�D`AorPi. D=�,<:;.-:'; `<?;""i;.w"':::_:.,":;:-`:;.::'.:;;-;;-'::-::-,.'<;:.=:`::;;;,:::.: :.,,,': �"::<""::.,::::-":•;'_;-<' .`::: ',"`.,,�. ....._:,'.-::.:-:.;:, �:-a.. : .. .;"::I..•.=.- :.: L conn if amH�ate.lals are ^. LS . art qT spinproject. ...;...., `M. Cop}Copy of Planum PProeal Letter or bleeting with Planning prior to submittal of Building Permit application. -:;;:,,;: ,=_: ":,,,:__:::::.:::< _•::::: .:::::::.._:.. •�a::i4J©R. ">'_-=: =€,=''::_:=';i " �._ e:•:::::.r:.:�,._�.,---::�::":".Y_=�.--:::::,.•.:: ,..:.- ;:: .,_,:.::: ;::_„ . y;.:"z:: ";_ -;w_,:_•...,::: =: :,,"_.S-0.IrI4RY'.SE�iERDISTRICT.';t•:' :;.�:.-::=:� z.:-.�,;_-=:�.:��.>:._.__::::..:"...:...:-:._:,::-_:. :::.,,�:::::•;:..-:-.__.::..,.:. Bld,-App_2011.doc revised 06121/11