B-2017-1085CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1085
10201 TORRE AVE CUPERTINO, CA 95014-2131 (369 41 005)
SPRIG ELECTRIC CO
SAN JOSE, CA 95112
OWNER'S NAME: I & G DIRECT REAL ESTATE 21 LP
DATE ISSUED: 07/07/2017
OWNER'S PHONE: 408-298-3134
PHONE NO: (408) 298-3134
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-10 Lic. #29672$
Contractor SPRIG ELECTRIC CO Date 04/30/2019
X BLDG X ELECT —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:
LAB 126 -11. RELOCATE (1) RECEPTACLE AND 1 DATA PORT
I hereby affirm under penalty of perjury one of the following two declarations:
(CONFERENCE ROOM)
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
r� performance of the work for which this permit is issued.
3. 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: $8000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
369 41 005
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 aga' st liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue again id City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the nt understands and will comply with all non point
source regul on pe the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatu Date 717/2017
Issued by: ABBY AYENDE
Date: 07/07/2017
DECLARATIO
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 roofmg material being installed. If a roof is
1. 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
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
z. 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: 7/7/2017
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
z. 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. 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
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
air contaminants as defined by the Bay A lAir Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cu ti unicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code s 5505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent-
APPLICANT CERTIFICATION
Date: 71712917
I certify that I have read this application and state that the above information is
CONSTR QfTON LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this pe#fnit 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
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 717/2017
Professional
toe's
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
im 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildincl(aDcuoertino.org
CUPERTINO I F1NEW CONSTRUCTION F-1ADDITIONADDITION I I ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
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DESCRIPTION OF WORK I ec to to cav
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
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TYPE
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VALUATION (S)
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DEMO
TOTAL
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TOTAL DECK/PORCH ARE
GARAGE AREA: DETACH
ATTACH
I
d DWELLING UNITS:
IS A SECOND UNIT YES
SECOND STORY []YES
BEING ADDED? [3NO
ADDITION? []NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
EIV ED BY:AL
VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
NO
EICHLER HOME? [314000"50
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 Tread this
application and the information I have vided 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 ding construction. I authorize representatives of Cupertino to enter the abov fide tified property for inspection purposes.
Signature of Applicant/Agent Date: 77/][
SUPPLEM TAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Mu amily 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
11 STANDARD
El PUBLIC WORKS
_
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
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ F.NVIRONMF,NTAI, HEALTH
B1dgApp_2011.doc revised 06/21/11