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B-2017-1421
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1421 10697 CULBERTSON DR CUPERTINO,CA 95014-3554(375 36 034) ALI'S CONSTRUCTION • &REMODELING INC • SAN JOSE,CA 95129 OWNER'S NAME: NARKAR ROHIT P AND PRIYANKA R _ DATE ISSUED:08/24/2017 OWNER'S PHONE:650-440-2923 • PHONE NO:(408)441-0967 EICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#909433 Contractor ALI'•S CONSTRUCTION&REMODELING INC Date 01/31/2018 XBLDG XELECT _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: (N)TEMPORARY POWER POLE(100 AMP) I hereby affirm under penalty of perjury one of the following two declarations: i. 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. V 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:$1000.00 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 375 36 034 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 gra of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will co ' h all non-point source regulations per the Cupertino Municipal,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ure a Date 8/24/2017 Issued by:Jasmine Archbold Date:08/24/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's,License Law for one of the BE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofmg material being installed.If a roof is i. 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:8/24/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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 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 Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,255 ,and 4 Labor Code,I must forthwith comply with such provisions or this permit shall AI"be deemed revoked. Ow•-r, authorized agent: APPLICANT CERTIFICATION e:8/24/2017 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 I 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. I understand my plans shall be used as public records. Signature Date 8/24/2017 Licensed Si g Professional CONSTRUCTION PERMIT APPLICATION M 1 \/"� / COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION B . V10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 s (408) 777-3228 • building@cupertino.org PEMIT#B-B2Ol4 - L''Z--t • CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. MEP ❑RE-ROOF ❑SWIMMING POOL/SPA `PROJECT ADDRESS&H� „ . e jJ®� N# ^ 1 ' ��— 0 V� OWNER NAME gotr (�.��r(b`'`!.s/x`J ONE J9- /7U��J E C !0 STREET ADDRESi®z,f ceezn/6©yi CITY, STA(TE, IPe 4_Lew ^A s-CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE fjZ 51- ,:zensfrxekailtee/.041i 40ey 6 . IS 7w, be EET ADD � CITY,STATE ZIP /SMS cc/ nfs7 E-MAIL- PHONE BUS.LIC# f�/t- J srr /? :di 4( ?-9W-'1E7 ' 'kb© e. 0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT Wye/CONTACT NAME C9.� I`�yl � n EMAIL ^ / • —� ,�// C/,/� ^ ®0�� . STREET DD ESS J/�/F � 'C//S' CITY,Tiy,,(/J,ZII� �,/PHONE /0,'c D i- Rid_ 3 - rf, 5-ai •dig gg/-®rs7 DECRIPTON - 4 - 7.-49 AO irA " ..„„, __.„„, ./.... '.e A • • - ❑SINGLE-FAMILY/DUPTEk 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC ' SQ.FT. VALUATION($) I REMODEL I 'REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED • MUSING ❑YES ! IC' FILER 0 YES SECOND STORY ADDITION 0 FIRE SPRINKLERS 0 NO' 1 I , ❑ NO 0 NO DWELLING SECONDS DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER UNITS.# UNIT ADDITONj.I D NO, SF POOLSI ❑FIBERGLASS, ❑VINYL-LINED 0 GDNITE 0 PREFABRICATED , POOL-SF SPA-SP!I I SPA ATTACHED ❑YES �., NO TOTAL-SF '. 1 BY: ,I '! T Tp�jL VALUATION: ,Cmnmercial or Multi-Faarily Buifdines.wiEh Public Seaimming Pools requires Deygrtment of Environmental Nenth ayyrovalTr.P Ii' ALU. I. 1,11 - � ff"""""CCTTg ) RE-ROOFI EXISTING ROOF'TYPE: ❑BUILT-UP ROOF El ASPHALT SHINGLES❑WOOD SHAKES EI WOOD SHINGLES❑TILE OTHER PECIFY REMOVE/REPLACE l NOI IFNO PLYWOOD ❑le ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS Q YEs; #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A PROPOSED ROOF TYPE:OW-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a.signed';'icopYl pf the Cupertino's Tear-Off Policy SF #of SQUARES By my signature below;Ii certify to,each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this apphcahon'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 building construction. I authorize representatives of Cupertino to enter the above identifiled property for inspection purposes. I aclmowled - : d authorize all*information contained on this application form to be made available for public record. ' Signature of,Applicant/Agent: / / Date: SUPPLEMENTALI NFORMAT 0 1 RE RED I'I I *New SFD/Second(belling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.' *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning IAp;prol al Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter o£"approval fromthe Home Owner's Association i' i Bldgpp_2017.doc revised 08/01/17