B-2016-1450CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1450'
19800 VALLCO PKWY CUPERTINO, CA 95014 (316 20 108)
(LAYTON
CONSTRUCTION CO
INC)
SANDY, UT 84070
OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT
DATE ISSUED: 03/01/2016
OWNER'S PHONE: 650-776-3226.
PHONE NO: 408402-1836
LICENSED ONTRA TOR' DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #79523$
Contractor (LAYTON CONSTRUCTION CO INC } Date 03/01/2016
X BLDG —ELECT X PLUMB
—
MECH RESIDENTIAL X 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:
(PREVIOUSLY ROSEBOWL)-REPAIR SINK HOLE FROM STORM
I-hereby affirm under penalty of perjury one of the following two declarations:
LEAK AND REPAIR STORM DRAIN
t. 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.
I 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
Sq. Ft Floor Area:
Valuation: $15000.00
this permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
Number:
Occupancy Type:;
information is correct. I agree to comply with all city and county
3160 108
316 2
ordinances and state laws relating to building construction, and hereby
authorize 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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. i a t understands and will
comply with all no m ource re es @e a Cupertino Municipal
180 DAYS FROM LAST CALLED LED IN TION.
Code, Secti .18.
Issued by: ALEX VALLELUNGA
Signature le 03/01/2016
Date: 03/01/2016
-DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
following two reasons:
I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 03/01/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. 1 have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
by Section 3700 of the Labor Code, for the performance of the work for which
Health & Safety Code, Section 25532(a) should I store or handle hazardous
this permit is issued.
e. I certify that in the performance of the work for which this permit is issued I
material. Additionally, should I use equipmen vice "'ch emit hazardous
air contaminants as defined by the Bea Air ty na ement District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with t upertino ode, C pter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safe ode, S S, 33 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agent,
be deemed revoked.
Date: 03/01 /2016
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
RUCT LEND ENCY
I hereby affirm that there is a constructi nding agency for the performance
work's for which this permit is is (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state lawsof
Lender's Name
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 03/01/2016
e
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 • buiiding(d)cuperdno.org
A PLUMBING
PROJECT ADDRESS i pr F)Q v
allco
OWNERNAME � 0I p
APN n ° `I' 2-0 V
MEP
misc
NEOUS
1 1 CITY, STATE, ZIP FAX
STREET ADDRESS''
//
CONTACT NAME { [ /) E v l � J
��jj
PHONE �l U (� E-MAIL FCcc /ej ��i�i�`Ufie d
STREET ADDRESS O f
CITY, STATE, ZIP 54-7 `a5� , C/ /®
FA}
❑ OWNER ❑ OWNER -BUILDER ❑ OWNTERAGENT CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME il111%e'�%_ /l� f^ d p
d/ G /
LICENSE I3iJMB Cy��
!
LICENSE T
BUS. LIC # ",�,aZ� _ o
yJ Jilt
COMPAATY NAME
" dl !;,trvC I i&7
E-MAIL
(SOD)
FAX
STREET ADDRESS 2Z � 46 � (v „j
(�
CITY, STATE, ZIP (�� j® e S� � / ®
J �p C
PHONE / &36_
F
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC �
COMP? NY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFI; o,DUPLEX ❑ MULTI -FAMILY PROJECT INWILDLAND ❑ YES PROJECT IDT- ❑ YES
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑. NO
DESCRIPTION OF WORK
V' 6 n�9 f%%� CYII1!y�! t _ jLie 0 Z r
�l`�. J\
TOTAL VALUATION: /CGI, RECEREDBY
By my signature below, I- certify to 9offof the oll "ink: I ai the property owner or authorized agent to act on the prope owner's half. I e read this
application and the information I ve p�isom2ct.ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relat g to b uthorize representatives of Cupertino to enter theabove-idened pr�� ' for inspection purposes.
Signature of Applicant/Agent: Date: 3 //f -L
INFORMATION
A7EPh1IiscApp_2011.doc I-evised 06/21/11