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B-2018-1263 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CON'T'RACTOR: PERMIT NO:B-2018-1263 10149 S BLANEY AVE APT B CUPERTINO,CA 95014-3156(369 03 008) Lake Biltmore Apartments 1900 S.Norfolk St Suite 150 San Mateo,CA 94403 OWNER'SNAME:Lake Biltrame Apo'nneuts DATE ISSUED:07/30/2018 OWNER'S PHONE:650-504-6641 PHONE No:650-504-6641 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lie.# Contractor Lake Biltmore Apartments Date X BLDG ELECT_PLUMB 1 hereby affirm that I am licensed under the provisions of Chapter 9(oomnencing —MECH X RESIDENTIAL—COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my Ilcense Is In full force and affect. JOB DESCRIPTION: TJ-IE BILTMORE APARTMENT-Remodel Apartment:UNIT A I hereby affirm under penalty of perjury one of the following two declarations: "BISMARK".Remodel Bath(49 S.F.);Remodel Kitchen(90 S.F.);Remodel a I have and will maintain a certificate of consent to self-insure for Worker's Other(32 S.F.);New Lights(5 Total);New Outlets(5 Total);New Compensation,as provided for by Section 3700 of the Labor Code,for the Condenser/Fan Coil System.Floor plans are on Master Permit Number B- performance of the work for which this permit is issued. 2017-1522. z. 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. - Sq.Ft Floor Arca: Valuation:$16800.00 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 36903 008 representatives of this city to anter 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. Signature Date 07/31/2018 Issued by:Jasmine Archbold Date:07/30/2018 OWNER-BUILDER DECLARATION I hereby affirm that 1 at.exempt from the Contractor's License Law far one of the RE-ROOFS following two reasons: All..is shall be inspected prior to any roofing material being installed.if a roof is u 1,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) 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant contractors to construct the project(Sec.7044,Business&Professions Code). Dole:07/31/2018 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 I'or Worker's Compensation,as provided for by Section 3700 of the Labor Corte,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 1 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,Sectlous 25505,25533,and 25534.1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the �}a 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should 1 stare 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 Aren Air Quality Management Dish id 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,Section 550.,.,2553 Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: ✓�' APPLICANT CERTIFICATION Date:.07/39/2018 I certify that I have read this application and slate that the above information isCONS'f12UCTlON LE DI AG. correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit Is Issued(Sec.30 ,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 perm't7 Additionally,the applicant understands and wit comply with all non-point sour 6gulations per the Cupertino Municipal ARC'HfPCT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Data 07131!2018 Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO.CA95014-3255 C UP ERTINO (408)777-3228•FAX(408)777-3333•building ftupertincLorg ❑NEW CONSTRUCTION ❑ADDITION b4 ALTERATION/TI Hyl❑ REVISION/DEFERRED ORIGINAL PERMIT it p�ZCI�-' lei fo,fV PROJ ECTADDRGSS i-�fo �'e �S(.l4a�E �� rr�/\ APNP OWNERNAME VVV rNONppIII./// E-MAIL �eE I OJs i a _ ('.... dy d ��0 mbeaa:.iFT asaa rsaa f STREET AD RES CIT STAT""' FAX CONTACT NAME y^� PI10N E-MAIL ®�ikvA�®_ �"t� ,J�' •�C+.,_�C';''O'.��S:,add IL,t'�c.�.;<a�'7 .fa:rowr"rlt�-tJSJ!� :E.I�'- STREBTADDR CITY,STATG s c . 1.➢r ee..6,Ud dSi] ,aa� 9M,3 ❑OWNER ❑OWNER-BUILDER ,9WNER AGENT ❑CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑'TENANT CONT CTORNAMB '� LICENSE NUMBER(y LICENS TYPE BITS.LICU COMPANY NAME E-MAIL . FAX 'Ljr-,O '_ Aj Cia:l4vaL �iu�,�r,� STR ET ADDRESS CITY,STATE,ZIP +( PH NE ii rva ::J..E:`" - .�.I l9}5" t},1Lc- 9'4>afa'�- C ..�? ' r"7/.,1/2S'_9 ..� ARCHITECUENGNEER NAME LICENSE NUMBER BUS.LIC 11 COMPANY NAME &MA.1 FAX STREET ADDRESS CffY,STATE,ZIP PHONE DESCRIPTION OFwo. Remodel Apartment: UNIT A"BISMARK". Remodel Bath(49 S.F.); Remodel Kitchen(90 S.F.); Remodel Other(32 S.F.); New Lights(5 Total); New Outlets(5 Total) ; New Condensor/Fan Coil System. Floor plans are on Master Permit Number B-2017-1522. EX[STmGUSE PROPOSED USE CONSTRAYPI''. 1 1111 RIES USE TYPE OCC. SQ.FI'. VALUATION(S) EXIS'fG NEW FLOOit DEMO TOTAC -XIS AREA AREA NETAREA BATT ROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCHAREA DECEAREA l'0"I'AL DGCWPORCII AREA GARAGE ARBA: DETACH TTACII #DWELLINGUNDS: IS A SECOND UNIT []YES SECONU STORY ❑YEs REINGADIIEn? ❑NO ADDITION? ❑NO PRAPPLICATION []YES IF YE.S,PROVIDECOPYOF IS"I'IIN BLDG AN ❑YES .LVED PY: TOTAL VALUATION: PI.ANNINGAPPLff FIND PLANNING APPROVAL LETTER EICULERHONIE? E]NO &B// ��r�� By my signature below,I certify to each of the following:1 am the properly owner or authorized agent to act on the property owner's behalf.l have read Ihis application and the information I have provided is correct.I I vc read the Description of Work and verity it is accurate.I agree to comply with all applicable local ordinances and state laws relating to bulk iIro c nstru Ra.I rthOrize representatives of Cupertino to enter[1 above-idea-ified T perty for inspection pwposes. Signature of Applicant/Agcal v' - Date: - 2 �V SUPPLEMENTAL INFORMATIONREQUIRED PLAN CHFICKTYPE ROUTINGSLIP New SFD or MUltifamily dwellings: Apply for demolition permit I'or ❑ OVER-rue:-COUNTPat ❑ BUILDING PLAmUtVIEw existing building(s).Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS lorm if any Hazardous Materials are being used as part of this prgjcCL ❑ LARGE ❑ r•IREBFPT —Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ snmTARV SrWCRDISTRICT Submittal of Building Permit application. ❑ ENVIRONNUNTALNEALT'1{ BldgApp_2011.doc revised 06/2J/I