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B-2016-1569CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1233 BELKNAP CT CUPERTINO, CA 95014-4904 (362 10 023) CONTRACTOR: PERMIT NO: B-2016-1569 GREGORY MILTON AND JUDY TRUSTEE - 1233 BELKNAP CT CUPERTINO, CA 95014-4904 OWNER'SNAME: GREGORY MILTON AND JUDY TRUSTEE DATE ISSUE .03/17/2016 OWNER'S PHONE: PHONE : None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT IN License Class Lic. # Contractor GREGORY MILTON AND JUDY TRUSTEE Date X BLDG — ELEC X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business — MECH X RE ENTIAL — COMMERCIAL & Professions Code and that my license is in full force and effect. JOB DES PTION: I hereby affirm under penalty of perjury one of the following two declarations: MOVE AS METER TO NEW LOCATION (GALA t. 1 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. z. 1 have and will maintain Worker's Compensation Insurance, as provided f y Section 3700 of the Labor Code, for the performance of the work for w 'ch this permit is issued. Sq. Ft Floor Area: Valuation: $2000.00 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 countydinances and state laws relating to building APN Number: Occupancy Type: construction, and hereby autfiorize representatives of this city to enter upon the above mentio�A property for inspection 362 10 023 purposes. (We) agree to save indemnify and cep harmless the City of Cupertino against liabilities, judgments, costs, d expenses which may accrue against said City in consequence the PERMIT EXPIRES IF WORK IS NOT STARTED of • ranting of this permit. Additionally, the applicant understands and willcopniply with all non -point source WITHIN 180 DAYS OF PERMIT ISSUANCE OR regulations per the Cupertino Municipal ode, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: PAUL O'SULLIVAN Date: 03/17/2016 OWNER -BUILDER DECLARATI� I hereby affirm that I am ex from the Contractor's License Law for one of the following two reasons: r RE -ROOFS - 1. 1, as owner of the property, or my employees with wages as their sole 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 compensation, will do the work, and the structure is not intended or offered for inspection. sale (See. 7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 8u HAZARDOUS MATERIALS DISCLOSURE 'r 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. 1 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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information is CONSTRUCTION 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 Code, Section 9.18. ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Signature Date Licensed Patricia Garcia From: Sent: To: Subject: Yes that is Correct. Thanks, Milton Gregory Milton Gregory <milt@sunrise-wireless.com> Monday, March 06, 2017 9:30 PM Patricia Garcia RE: Permit # B-2016-1569 From: Patricia Garcia [mailto:PatG@cupertino.org] Sent: Monday, March 06, 2017 9:17 AM To.: 'Milton Gregory' Subject: RE: Permit # B-2016-1569 Mr. Gregory, Just to confirm the permit to move gas line was B-2016-1569 and this is the permit you wanted to cancel. Kindly, Clay O f CLLP rt"10- 3l')ept. 408.777 3228 - �aG(�c.�tipew�- From: Milton Gregory [mailto:milt@sunrise-wireless.com] Sent: Monday, March 06, 2017 7:55 AM To: Patricia Garcia <PatG@cupertino.org> Subject: Permit # B-2016-1569 Per our conversation on Thursday, please cancel permit B-2016-1563. We will not be moving the gas meter. thanks, Milton Gregory Total Control Panel Loem To: patg(a�cunertino org Remove this sender from my allow list From: milt@sunrise-wireless.com You received this message because the sender is on your allow list. 1 R, El, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1569 1233 BELKNAP CT CUPERTINO, CA 95014-4904 (362 10 023) GREGORY MILTON AND JUDY TRUSTEE 1233 BELKNAP CT CUPERTINO, CA 95014-4904 OWNER'S NAME: GREGORY MILTON AND JUDY TRUSTEE DATE ISSUED: 03/17/2016 OWNER'S PHONE: 408-892-2748 PHONE NO: None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor GREGORY MILTON AND JUDY TRUSTEE Date 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: MOVE GAS METER TO NEW LOCATION (GARAGE) I hereby affirm under penalty of perjury one of the following two declarations: 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. 2. 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 this Sq. Ft Floor Area: Valuation: $2000.00 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 362 10 023 362 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 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/13 7/16 Issued by: ABBY AYENDE Date: 3/17/16 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is follw' , two reasons: 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 11 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: 3/17/16 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 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 Chapter 9.12 the rmit is issued. maintain compliance with the Cupertino Municipal Code, and 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 material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Miner or authorized agent: APPLICANT CERTIFICATION tate: 3 17/16 I certify that I have read this application and state that the above information is CONSTRUCTION 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 sou ce regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. I understand my plans shall be used as public records. Date 1716 Licensed natur IJw"'– OF Uv CUPERTIN0 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(1cupertino.org 'pi -2w -e -lap V .r XPLUMBING ❑ MECHANICAL ❑ELECTRICAL ❑ MISCELLAINIEOUS PROJECT ADDRESS 7 7 kV APN j ��} 10 � o'�J 5 OWNER NAi V 1 Vb1 PHO S ESS V� CITY, STAT ZIP FAX C CONTACT NAME PHONE E-MAIL STREET.ADDRESS CITY, STATE, ZIP FAX A OVNRQER ❑ OwNER-BUILDER ❑ OMINTERAMTT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE N 17JMBER LICENSE TYPE BUS. LIC # COMPANY NAME IL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER HAME LICENSE NUMBER BUS. LIC 4 COMP. AME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF T 1 SFD crDUPLEX ❑ MULTI -FAMILY PROJECT IN wII-DLAN'D ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDLNG: ❑ COMMEERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: :xRECEIVED BY ` {k. By my signature below, I certify to each of the following:I a the property owner or authorized agent to act on the property ow er's beh Ii I have read this application and the information I have provide is coir t. I e read the Description of'Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating tg4uild' St. Mthorize representatives of Cupertino to enter the above-identi red property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMYTJN REQUIRED OFFICE.iTSE Ol\Ll,,,.� s r D �O}ER,THE COUNTER F' ❑ EXPRESS Y ❑ STANDARD, v z a r s ❑ AfAJOR s„�' S MEPAIlls cApp_2011.doc revised 06/21/11 Remove gas met( from current locat Reinstall gas meter new location CUPERTINO Building Department �AIAPt 17 2016 REVIE NED FOR CODE COMPLIANCE RBviewed By: cwt ".%flUNiTYDEVELOPMENT DEPARTMENT UI-DiNG DIVISION - CUPERTINO if'-atlons MUST be kept at the tion. It is unlawful to make any -�fl` -F-tjor- I- on sa mig, or to deviate YV"Z;-wiAla-pp! 'Ovai from the Building Official. Of t!,iS PIE," M"d specifications SHALL NOT LO it or to bean a-Proval of the violation of ,ny provi4ionsQf any City Ordinance or State Law. BY\AAA V "-Y LU! �A_ DATE PERMIT NO. ll 1-j Q& Code: 2013 C7RC Scope of Wbrk: Relocate/gas meter of trench to uncover / existing service 2. PGE to remove meter from currrent location 3. PGE to re—install at new approximately 4 ft from current location and reconnect service 4. Pool contractor or plumber to trench as needed and reconnect service to pool heater Occupancy group: R -3/U Construction, type: VB Gregory Residence 1233 Belknap Ct Gas Meter Relocation 3-17-16 Remove gas from curren-,-- Re'Insta meter�� � oca-,--ion iIJ gas meter location Ct.,lF' ERTINO B-;iding Department 2016 r E`�.�iEVVED i OR, CODE COMPLIANCE Reviewed By: �Iftm uvwj Gregory Residence 1233 Belknap Ct Gas Meter Relocation Detailed View 3-17-16