B-2017-1854 - CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1854
1514 POPPY WAY CUPERTINO,CA 95014-5307(366 10 113) SDP PLUMBING INC
SAN FRANCISCO,CA
94124
OWNER'S NAME: HO EMMYAND MICHAEL DATE ISSUED: 10/30/2017
OWNER'S PHONE:408-309-9463 PHONE NO:(415)730-0937
A
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
•
License Class C-36 Lic.#1016070
Contractor SDP PLUMBING INC Date 07/31/2018 X BLDG _ELECT X 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 SEWER MAIN;REPLACE BUILDING SEWER
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
rformance.of the work for which this permit is issued.
• 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:$8000.00
• 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 366 10 113
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.
ture Date 10/30/2017 Issued by:Abby Ayende
Date: 10/30/2017
0 • LDER 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 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:10/30/2017
•
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 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 mot'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 ections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 0 n or authorized a,-
• APPLICANT CERTIFICATION e:10/30/2017
I certify that I have read this application and state that the above information is CO 'UCTION 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.
Licensed
Signature _ Date 10/30/2017 Professional
CONSTRUCTION PERMIT APPLICATION
\,t /// COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
(408)777-3228 • building@cupertino.org PEMIT#B- _n
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF p SWIMMING POOL/SPA
PROJECT ADDRESS ` .„s-.'u I ji, APN# re , 10+t
OWNER NAME P a &het`�✓1 ,-- PH 3c i�kivi brep tig,o_ C6�
STREET ADDRESS CTE' :
❑CONTRA'CTO NAME OWN - DER CO Y NAME CENSEnNUMBER A LICENSETYa
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STREET ADDRESS /�� ► ATE,ZIP
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0 ARCHITECT 0 OWNER 0 OWNER AGENT 0 CONTRACTItIR CONTRACTAGENT ENGINEER 0 DEVELOPER 0 TENANT
CO . NAME E-MAIL
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*GU-FAMILY/DUPLEX 0 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 ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
' FIREEXISSPRINKLERS- NO YES EICHLER No NG SECOND STORY ADDITION
DWELLING SECOND DWELLING 0 YES 0 ATTACHED 0 DETACHED OTHER I
UNITS#,, UNIT ADDITON: 0 NO S F
POOLS` ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
RE BY:BY: n TOTAL�' VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval 11 �U�Y (at Q C- VAe)y ��
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NOI IF NO PLYWOOD ❑'�" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES #OF LAYERS THICKNESS I=15/8" OTHER ElOSB ElCDX 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 .-. :erty owner or authorized agent to act on the property owner's behalf. I
have read this application and the information I haus .rovided i o ect. ,/'ave read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordin r...s . •:'f tate laws -1 . 'building construction. I authorize representatives of Cupertino to
enter the above-identified property for in•.•cti t, . rposes. /a .nT•dge and authorize all information contained on this application form
to be made available for public record. //
Signature of Applicant/Agent: Date:/0 '30 - 1)
i SUPPLEMENTAL INFORMATION R%•IRED
1 *New SFD/Second Dwelling Units/M i. .. 'y Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
I *Commercial Buildings: Provide a c• pleted 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