Loading...
BLD-2023-2713_SignedPermit.pdf ITY OF BUILDING PERMIT CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 PHONE 408-777-3228 CUPERTINO WWW.CUPERTINO.ORG BUILDING ADDRESS: 10101 RICHWOOD DR APN: 369 08 035 PERMIT NO: BLD-2023-2713 OWNER'S NAME: MASSIHPOUR SHARAREH OWNER'S PHONE: CONTRACTOR: LANDMARK ROOFING CONTRACTOR PHONE:408-674-4503 DATE ISSUED: Dec 6. 2023 ISSUED BY: Kim Dunbar VALUATION: 17000 JOB DESCRIPTION: RE -ROOF; TEAR -OFF; COMP SHINGLE (22SQ) CLASS A LICENSED CONTRACTOR'S DECLARATION: NO: 1014538 EXP DATE: 05/31/2024 7000) of Division 3 of the Business & Professions CONTRACTOR: LANDMARK ROOFING LICENSED CLASS:C39 LICENSED ROOFING I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section Code and that my license is in full force and effect. as provided for by Section 3700 of the I hereby affirm under penalty of perjury one of the following three declarations: ❑ I have and will maintain a certificate of consent to self -insure for Worker's Compensation, Labor Code, for the performance of the work for which this permit is issued. Section 3700 of the Labor Code, for the not employ any person in any manner so as to this certificate of exemption, I become subject to with such provisions or this permit shall be I. I have and will maintain Worker's Compensation Insurance, as provided for by performance of the work for which this permit is issued. ❑ I certify that in the performance of the work for which this permit is issued, I shall become subject to the Worker's Compensation laws of California. If, after making the Worker's Compensation provisions of the Labor Code, I must forthwith comply deemed revoked. HAZARDOUS MATERIALS DISCLOSURE & Safety Code, Sections 25505, 25533, and 25534. I M I have read the hazardous materials requirements under Chapter 6.95 of the California Health will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or air contaminants as defined by the Bay Area Chapter 9.12 and the Health & Safety Code, handle hazardous material. Additionally, should I use equipment or devices which emit hazardous Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Sections 25505, 25533, and 25534. EPA LEAD -SAFE DISCLOSURE No: ❑ An EPA Lead -Safe Certified Renovator will be responsible for this project. Certified Firm Name: Firm Certification ✓ No EPA Lead -Safe Certified Firm is required for this project. CONSTRUCTION LENDING AGENCY of the work which this permit is issued I hereby affirm under penalty of perjury that there is a construction lending agency for the performance (Section AV7, Civil Code). Yes El No Lender's Name: Lender's Address: APPLICATION CERTIFICATION with all city and county ordinances and state the above mentioned property for inspection judgements, costs, and expenses which may understands and will comply with all non -point I certify that I have read this application and state that the above information is correct. I agree to comply laws relating to building construction, and hereby authorize representatives of this city to enter upon purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, accrue against said City in consequence of the granting of this permit. Additionally, the applicant source regulations per the Cupertino Municipal Code, Section 9.18. Signature `'2, jeea'`�G�-ez/- Date Dec 6, 2023 EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 365 DAYS AFTER ITS ISSUANCE, OR IF THE WORK AUTHORIZED ON THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF 365 DAYS AFTER THE TIME THE WORK IS COMMENCED. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • permitcenter@cupertino.org PERMIT #B -I�-- CUPERTINO I REV # DEF # ❑ NEW CONSTRUCTION []ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP E2fRE-ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS APN # _ OWNER NAME P ONE E-MAIL 'Sh'aw Mqssl� nor STREET ADDRESS CITY, STATE, ZIP Ef CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME L LICENSE NUMBER LICENSE TYPE c3� STREET A DR SS CITY, ATE, 1koP . S Cc.. S 2 t r PHONE BUS. LIC # ` 6t ` ( 6 o� 7 - -1'S o ❑ AYcHrrEcY ❑ OWNER ❑ OWNER AGMT RTCONTRACTOR AGE E GINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME E-MAIL C , ` a� Cawl STREE AD ESS CrrY, TATE, Z PHO E © S c2 DESCRIPTON 4 TOTAL VALUATION: D 00 ❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) EXISTING USE EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF I STORIES # I TOTAL NET SF REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED EXISING ❑ YES EICHLER ❑ YES SECOND STORY ADDITION ❑ YES FIRE SPRINKLERS ❑ NO ❑ NO ❑ NO DWELLING SECOND DWELLING []YES ❑ ATTACHED❑ DETACHED OTHER L7NITS # UNIT ADDITON: ❑ NO SF POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO I TOTAL - SF RECEIVED BY: Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES[] WOOD SHAKES ❑ WOOD SHINGLES ❑ TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO IF NO PLYWOOD ❑ ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑ YES # OF LAYERS I THICKNESS ❑ 5/8- OTHER ❑ OSB ❑ CDX OTHER 12 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 #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 state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. 7 — C v Z 3 Signature of Applicant/Agent: Date:—) SUPPLEMENTAL INFORMATION REQ RED *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 01101121