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Home My WebLink AboutB-2017-1828do CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1828 21373 DEXTER DR CUPERTINO, CA 95014-1316 (326 41 087) AAA ELECTRIC SAN JOSE, CA 95121 OWNER'S NAME: CHAMBERLAIN PARK AND JOAN B TRUSTEE DATE ISSUED: 10/25/2017 OWNER'S PHONE: 408-365-3806 PHONE NO: (408) 557-8899 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic. #741094 Contractor AAA ELECTRIC Date 10/31/2017 X BLDG X 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: INSTALL 8 LIGHT FIXTURES; 3 CIRCUITS (20 AMPS) - KITCHEN I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 have and will maintain a certificate of consent to self-insure for Worker's C pensation, as provided for by Section 3700 of the Labor Code, for the ance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by 1 Section 3700 of the Labor Code, for the performance of the work for which this Sq: Ft Floor Area: Valuation: $4000.00 \ permit is issued. 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 32641 087 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 Cityinconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applican . nderstands and will comply with all non-point source rnicipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ff elnatur�� Date 10/25/2017 Issued by: Abby Ayende Date: 10/25/2017 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 r. 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: contractorsjto construct the project (Sec.7044, Business & Professions Code). Date: 10/25/2017 1 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 z. I have aud,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 it Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with Code, Chapter 9.12 and exemption,'I become subject to the Worker's Compensation provisions of the the Health & Safety 550 33, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall ffitheiMunicipal be deemed revoked. , inner or authorized agen . APPLICANT CERTIFICATION Date: 10/25/2017 I certify that I have read this application and state that the above information is T T LE DI correct. I agree to comply with all city and county ordinances and state Maws 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 consequerice 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 10/25/2017 Licensed professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1 (408) 777-3228 • bLdIdin @cuPertino.org PEMIT ✓fB CUPERTINO REvp- DEF9 n NFW C'(_)NRTRTT('TT(-1N 71 AnnTTTnN n AT TFRATTf1N n T T n nAFP F IRF-RnnT7 7.SWTMMTN(: T,r)nT /SPA PROJECT ADDRESS )APN i O A LV 1A yl PH PQFj �YIC J E-MAIL STRE�Tk-5-4-31 LV` o� ATE IPC/� NTRA' TOR NAME [IOWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE STREET ADDRESS log ,6%V[ ��A ,n ,, ` (/ a "[PHO �l C STATE, ZIP � - I� / � j c7w / MAIL BUS. LIC a r-*El ARCHITECT ❑ OWNER ,.❑ OWNER AGENT ❑ CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT ' CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DECRIPTON ,EPSINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION (S) EXISTING USE EXISTING SI, NEW FLOOR SF PORCHSF DECKSF DEMOSF STORIES z TOTALNETSF REMODEL ,i 'BATHROOM .'SF !REN40DEL KITCHEN SF - REMODELOTHR GARAGE 5F SF ❑ ATTACHED ❑ DETACHED EXISiNG ❑DYES!� , 'FIRE SPRINKLERS ❑ NO 'i �i EIEHLER ❑ 'YES '' . El. NO SECOND STORY ADDITION ❑ YES ❑ NO DWELLING • SECOND DWELLING []YES ❑ ATTACHED[] DETACHED OTHER 'UNITS # UNITADbrrON:: ❑ NO 5F i - POOLS i i❑'FTBERGLA ,S' ❑ VINYL-LINt b ❑ GUNITE ❑ PREFABRICATED 'POOL -SF SPA -,SF` SPA ATTACHED [3 YES ❑ NO TOTAL -SF Commercial or, Milli-Famf l Buildings with Public Stuinmiing Pools requires Department o(Environmental Heath approval RECEIVED BY: TO L VALUATION: RE-RO OF iEX'ISnNG ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ TIL OTHER (SPECIFY) REMOVE/REPLACE ❑NO YES IFNO p OF LAYERS PLYWOOD ❑'� ❑3/8" PLYWOODTYPE: THICKNESS ❑ 5/8" OTHER ❑ OSB ❑ CDX OTHER PITCH: • 12 ROOF CLASS A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER *Provide a signed copy of the Cupertino's Tear -Off Policy SF ;ofSQUARES 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, rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordin s d ting to building construction. I authorize r present tives of Cupertino to enter the above identlfied;;property for ' 0, S. ac ivledge and authorize all informaHglcol acne / this ap lication form to be made available for public recor. Z Signature of Applicant/Agent: Date: ((//IIVVJJ SUPPLEMENTAL INFORMATIO REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a buildingTermit 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 BIdgApp_2017.doc revised 08101117