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B-2016-2020
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2020 23800 AMAPOLO CT UNIT 3 CUPERTINO,CA 95014.-6539(342 54 005) BAY AREA ENTERPRISE SAN JOSE,CA 95148 OWNER'S NAME: DEKRAKER GLENN M TRUSTEE&ET AL DATE ISSUED:05/25/2016 OWNER'S PHONE:408-537-1523 PHONE NO:(408)238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.# 17 17 Contractor BAY AREA ENTERPRISE Date 03/31/2017 X BLDG X ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: (R)15 RECESSED LIGHTS,4 ELECTRICAL OUTLETS;3 N LIGHT I hereby,affirm under penalty of perjury one of the following two declarations: SWITCHES;(N)GAS LINE 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. z 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 permit is issued. Sq.Ft Floor Area: Valuation:$9000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type: 34254 005 and state laws relating to building construction,and hereby authorize 342 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 ap icant unqPNtands and will comply with all non-point source regulations r the C te,ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. /Signature . Date 5/25/2016 Issued by:Abby Ayende C/ Date:05/25/2016 OWNER- LDER416LARA ION 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 roofing material being installed.If a roof is 1. I,as owner of the properly,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: /255 /2016 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued,I 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. C Own or authorized agent: APPLICANT CERTIFICATION Date:5/25/2016 CONS GAGENCY certify that I have read this application and state that the above information is I N N 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, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 5/25/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10304 TORRE AVENUE-CUPERTINO,OA 95014-3255 1 CUPER T INO (408)777-3228•FAX(408)777-3333•building@cupertino.oEg 2:01(9 AX 2V ❑NEW CONSTRUCTION ❑ ADDITION TERATION/TI ❑ "VISION/DEFERRED - ORIGINAL PERMIT 4 PROJECT ADDRESS >> APN# 3(600 14In� �/O —502 OWNER NAMEPHO1v'E E T+rFAII, Tk f6ru M '1, V1 1 b— 3 lSZ3 Fr7x,vs .c b Rsc-cdtA STREETADDRESS 0 CITY,STATE,ZIP A CONTACT NAME PHONE E-MATE, C»•e 'S -2.3 a -SOCA3 STREET ADDRESS - CITY,STATE;ZIP - FAX Z110 � a n `n �' J 0:OWNER ©OWNER-BUILDER ❑OWNER AGENT 0 C=ONTRACTOR Cl CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME t� LIC ENS NUMBER HCENSETYPE BUS.LIC# i -.. FAX - COIv1PANYNAME � E-MAIL ct rye C' VL ,d t' .t o STREET ADDRESS CITY=STATE,ZIP" PHONE z tt o a 57 $ YD ARCHITECTIENGiINEERNAME LICENSENUMBER BUS.LIC# COMPANYNAME - - EMAIL FAX STREET ADDRESS CITY,STATE,ZIP .. PHONE DESCRIPTION OF WORK ll \1 !� ►6r r Cel C;SCR�1 Z CFUr Y al'u�i l b lr � e �S S 3 Abe kl 1(' A+ 6Wr , c 4 Pew G 5 \l Yk'(1 EXISTING USE PROPO RUSE - CONSTR TYPE #STORIES USE TYPE OCC. SQ.Fr: VALUATION{$) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NEPAREA BATHROOM KITCHEN - - OTHER - REMODELAREA. REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: 0 DETACH ©ATTACH #DWELLINGUNTTS: IS A SECOND UNIT EIYES SECONDSTORY OYES BEINGADDED? ONO ADDITION? ©NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN OYES RE ,VIVEDBY_. - TOTALVALUATION_�,�. PLANNINGAPPL# ONO PLu%NENGAPPROVAL LETTER EICALERAOME? ©NO , IL y signature fY P g: property p authorized to act on the property owner's behalf. I have read this By In si ature beIov,I cern to each oftbe foIlo � I am the ro rty owner or authorized agent application and the information I have provided is c t_ I hav ead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons ction. Tr" o ze representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: SUPPLEMENT6L INFORMATION REQUIRED PLAN IUCKT3 PE ROUT'INGSLIP Nei-SFD or Multifamily dwellings: Apply for demolition,permit for b 6VIEW TH&COUNTER 1� BUiiD XGP AN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. .0 EXPRESS � PuwNNINGF3 A�IRET IE1V Commercial 131dgs: Provide a completed Hazardous Materials Disclosure fl P'rnrmAxv "PusT IcvvORIfS form if any Hazardous.Materials are being used as part of this project LARGE FIRISDEP7 _Copy of Planning Approval Letter Or Meeting with Planning prior to 0 MAJOR-' p SANITARY SEWER DISTRICT submittal of Building Permit application. 0 >ra«ROLunIIa rIrALREaLTR BldgApp 2011.docrevised 06121111 "?,•'.:k 'iD-r,,EV 'aJC-t'-!'9S-t P iV{Li� li til6 DIVI SON-CUPERTINO 4•._ - ¢ k ,0nns end Sp oj,cellons MUST be kept at the 6AMwivY i q.^.A�4Cj a` ei@Z�r le �u C3 1 came,dr t o it app -w- €at1ar c .ririt or toa r'l' ;p _ _ ,;,yiy provisions of any CIt Q Orie�o 'r v ( o n I j. w -- - te!`BEdt OQiC! w MSS Qi. via 6 6`%?. A9'— _ ` .�° g ii00 = — ' Passage_ ®= closets- limn'g 12-0x 9W Bath t# _ Kitch it 9 E} x 9 4" ,15'6'-x- Glbset — _ —I`3 - 1`9°®!6 = = - Oo IOse iilell x ` A ``x 73" 13x3& - - Bath - 5'1-x TO' �alCage ---- = -IZO'x 2W C6 Emergency Response System fl Electrical Outlet ii Cable Television Outlet IV Telephone Outlet _ =1 foot SJ'ta�lC C Villa INTERIOR quare SPACE 1,280 Square Feet t U� Two Bedrooms Two Baths TOTAL nEcx SPACE ��vn;y AT RANCHO SAN ANTONIO Floor plamarerehresemdue.Aff-Rwtm2+su�� ne V1,14 - !� r c. �; now, _E 0- !. z. # r {t qw� rj Hill ` T; a i i .F} _ Q IFF Amin 1peAr- 40 -x-n S 741- `r rf� � (30 va- i .t €_ OA is ' nor` k Hit, _lbs 31 If a