B-2017-1571 CITY OF CUPERTINO BUILDING PERMIT
•BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1571
1039 COLONY HILLS LN CUPERTINO,CA 95014-5801(359 30 002) B S B CONSTRUCTION .
HOLLISTER,CA 95023
OWNER'S NAME: GIARRETTO SHIRLEY B TRUSTEE DATE ISSUED:09/13/2017
OWNER'S PHONE:408-242-1322 PHONE NO:(831)636-2727
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#898550
Contractor B S B CONSTRUCTION Date 06/30/2019 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:
REPLACE WINDOW(12)-LIKE FOR LIKE;REPLACE WOOD
I hereby affirm under penalty of perjury one of the following two declarations: SIDING WITH STUCCO(800 S.F.)
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
erformance of the work for which this permit is issued.
I have and will maintain Wor.Cr' ompensation Insurance,as provided for by
Section 3700 of the La..' ::. .r the performance of the work for which this
permit is issued. / / Sq.Ft Floor Area: _
Valuation:$15000.00
APPLICANT CERTIFICATION
I certify that.l 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 359 30 002
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 IFWORK IS NOT STARTED
may accrue against said City in conseque ce of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the,applicant nderstands a. will comply with all non-point
source regulations per th-Cupertino M icipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
dip9 ature !Ai I� Date 9/13/2017 Issued by:Abby Ayende
Date:09/13/2017
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 roofmg 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:9/13/2017
i
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have:atid will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Sectioh,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
pe ttit 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 anagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino unicipa ode,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections505, : 3,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. „b?'ner or authorized agent: i A _
l APPLICANT CERTIFICATION )Date:9/13/2017 /
I certify that I have read this application and state that the above information is I` Vt --.` . `tl.'A - -` -
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,;end 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.
Licensed
Signature Date 9/13/2017 Professional
CONSTRUCTION PERMIT APPLICATION
\\ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ik
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 ��7y
ST.I91. �� `�J
s (408)777-3228 • building@cupertino.org PEMIT#B- -
CUPERTINO J REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS toy/
J j�`JJ� Colon 1`A J k,\1,C APN# 2 O.CO2
OWNER NAME , PHONE E-MAILw
. RSNSVA -PVT TA- 4D8 -242- 1322
STREET ADDRESS CITY! ll Lin CuS
ZR
1o34 pefiT1Ant col 44014 . 58o)
GnfOti Ha
CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
I /3S/3 Cc s4RwrsoN 8985s'a 13
ISTREET ADDRESS CITY,STATE, IP ' q So I
20 4 01;10r128 'Holl i S4Cu( GA
bS6anthfUCA 04/ a thou-634" NE 731 -
63 vizi BUS.LIC#
❑ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
R ec bV e i ; e �s ,l ohdow And 1 ns--aril new Sam e s i ze
ReAno r a 4 eX -ef tot chat Aha 1 n ski r elv Sew e size
. �?P ode s\A nts 1
AAA d o 5.��cco Joe 1� ° F T' �3 ti;a�
❑SIN -FAMILY/6U EX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I,
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL'KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF SFApp...- SF SF 0 DETACHED .
FIREESPRINKLERS 0 ESO EICHLER'❑❑NOS SECOND STORY ADDITION 0 YES
DWELLING SECOND DWELLING I,0 yEs ❑ATTACHED❑DETACHED OTHER
j NIT it UNIT ADDITON: 0 NO S F
POOLS' 0 FIBERGLASS 0 VINYL-LINED ❑GUNITE. 0 PREFABRICATED
POOL-SF SPA-SF . I; SPA ATTACHED❑YES El NO I TOTAL-SF
R EIVED BY: TOT L V,�LUATI :
Commercial or Multi,Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval fi a_A(Q p '•I..
RE-ROOFI EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHThkLES. TILE OTHER(SPECIFY) -
REMOVE/REPLACE❑NO IF NO PLYWOOD 0 ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES it OF LAYERS THICKNESS❑5/S" OTHER El OSB 0 CDX OTHER .12 A.
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES ,
By my signature below I,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 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 applicable;local ordinances and st. - laws relating to building construction. I authorize epresentatives of Cupertino to
enter the above-identified property for inspection pu.•.b se I'acknowledge and authorize all information c tained n this application form
to be made available for public record. 1-421
� /! /
Signature of Applicant/Agent: / ..� Date:
SUPPLEMENTAL INFORMATION REQUIRED /
*New SFD/Second Dwelling 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 Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17