B-2017-0302CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2.017-0302
21251 STEVENS CREEK BLVD CUPERTINO, CA 95014-5713 (326 29 006) COBE
CONSTRUCTION INC
CAMPBELL, CA 95008
OWNER'S NAME: CUPERTINO CITY OF
OWNER'S PHONE: 408-777-3354
LICENSED CONTRACTOR'S DECLARATION
License Class EJ Lic. #$35122
Contractor COBE CONSTRUCTION INC Date 03/31/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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. G Lhave 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.
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
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulaf s per the Cu rtino gni ipaI Code, Section 9.18.
Signature Kf ' Date 02/23/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
r. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
z, I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
DATE ISSUED: 02/23/2017
NO: (408) 371-3400
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
CUPERTINO SENIOR CENTER - REPAIR EXTERIOR WALL FROM
VEHICULAR DAMAGE
Sq. Ft Floor Area: I Valuation: $0.00
"N Number: Occupancy Type:
326 29 006
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROG INSPECTION.
Issued by:
Date: 02/2
RE -ROOFS:
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
inspection.
Signature of Applicant:
Date: 02/23/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF
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.
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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
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
be deemed revoked.
APPLICANT CERTIFICATION
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 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 may accrue against said City in
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.
Signature Date 02/23/2017
"A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, SyC 'ons 25505, 2553 , and 25
Owner or authorized ager
Date: 02/23/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUP R't"tN10 I (408) 777-3228 • FAX (408) 777-3333 buildingCa7cuperlino.orq
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'EXISTING USE
PROPOSED USE CONSTR.
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TYPE OCC.
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VALUATION (S)
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REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
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TOTAL DECKRORCH AREA
GARAGE AREA: DETACH �!
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES B -
EICHLER HOME? -
TOTAL VALU N:
By my signature below, I certify to each of the following: I am the property owner or authoriz agen 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 V6Rfy it is accurate. I agree t comply with all applicable local
ordinances and state laws relating to constructi-aA au o representatives of Cupertino to enter the above-' entified roperty for inspection purposes.
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Signature of ApplicantlAgent: Dater
SUPPLEMENTAL INFORMATION REQUIREDPLAN
CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLANREVIEW
_ New SFD. or Multifamily dwellings: Apply for demolition permit for
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 -
❑ ruBLTc woRxs
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
0 MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11