B-2017-1426CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR: .
PERMIT NO: B-2017-1426
10552 LA RODA DR CUPERTINO, CA 95014-4416 (369 33 02 1)
AMERICAN KITCHEN
& BATH INC
SAN JOSE, CA 95112
OWNER'S NAME: BARR DAVID TRUSTEE
DATE ISSUED: 08/24/2017
OWNER'S PHONE: 408-252-7156
PHONE NO: (408) 436-8151
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #513838
Contractor AMERICAN KITCHEN &, BATH INC Date 04/30/2019
X BLDG _ELECT _ PLUM
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:
1ST FLOOR HALL BATHROOM REMODDEL (44 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
m. 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 this
Sq. Ft Floor Area:
Valuation: $22700.60
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 33 021
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
Cityof 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.
�
y�ature / 0 7
Issued by: Abby Ayende
OWNER-BUILDER DECLARATION
Date: 08/24/2017
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 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: 8/24/2017,
i
•
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TOBE CLASS "A" OR BETTER
m. Lhave 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.
a. 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 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, Seciions.25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
:0 or authorized agent:
APPLICANT CERTIFICATION 0
Date: 8/24/2017
LENDING
I certify that I have read this application and state that the above information is
CONSTRUCTION AGENCY
correct. I agree to comply with all city and county ordinances and state laws
to building hereby this
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.)
relating construction, and authorize representatives of city
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 accruer 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 8/24/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
"M
iman 1 r
(408) 777-3228 • building@cupertino.org PEMIT #B - aol--�-
-
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
APN# '`'v
10552 La Roda Dr.
L ✓3— O2—(
OWNER NAME PHONE
E-MAIL
Barr 408-252-7156
edithsbarr@yahoo.com
STREET ADDRESS
CITY, STATE, ZIP
10552 La Roda Dr.
Cupertino, CA 95014
I] CONTRACTOR NAME ❑ OWNER -BUILDER
COMPANY NAME
LICENSE NUMBER
NSE TYPE
American Kitchen and Bath, Inc.
513838 TB
STREET, ADDRESS
CITY, STATE, ZIP
1758 Junction Ave., Suite D
San Jose, CA 95112
E-MAIL
BUS. LIC # ^ I / p
408-436-8151 IYJ�
shawn@americankitchenandbath.com
americankitchenandbath.com
C/�.
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DECRIPTON
Basic like for like bathroom remodel, no windows/door/wall being moved, all electrical will be energy efficient LED, all plumbing code compliant, tub/tile/floor/vanity unit replacement, fan
[]SINGLE-FAMILY/DUPLEX ❑MULTI -FAMILY ❑ INDUSTRIAL []COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
'EXISTING USE
EXISTING'.SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR GARAGE
❑ ATTACHED
:BATHROOM SF 44
SF
SF SF
❑ DETACHED
EXISING ❑YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES
❑ NO
SECOND STORY ADDITION ❑ YES
[]NO
DWELLING SECOND DWELLING []YES ❑ATTACHED❑ DETACHED OTHER
UNITS # UNIT ADD_ !TON: []NO S F
POOLS FIBE#6LASS ❑ VINYL -LINED ❑ GUNTTE ❑ PREFABRICATED
POOL, SF '' SPA - SF SPA ATTACHED []YES ® NO TOTAL - SF
Commercial oi.Multi-Fai l ihi (Buildings with Public Swhmnine Pools requires Deparhuent of Environmental Heath approval
REC B
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑'A" ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
YES
I # OF LAYERS
THICKNESS E]5/8" OTHER [:]OSB
[:]CDX OTHER
.12
A
PROPOSEDRODF TYPE, ❑BUILT-UP ROOF ❑ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES 11 OTHER
*Provide a signed, copy of the Cupertino's Tear -Off Policy
SF #of SQUARES
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 read this application and the information I have provided 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 to building construction. I authorize representatives of Cupertino to
enter the above -identified property for ins9ection purposes. I acknowledge and authorize all information ontamed on this application form
to be made available for public record.
Signature of Applicant/Agent: Date Z I
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildiiigs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
BldgApp_201 7. doc revised 08101117
08/25/17
B-2017-1426
Jasmine Archbold