B-2017-1638 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1638
10415 IMPERIAL AVE CUPERTINO,CA 95014-5931(357 19 100) HOLDER INC
SANTA CLARA,CA
95054
OWNER'S NAME: PATEL,BHAVESH CHANDRAKANT& DATE ISSUED:09/22/2017
OWNER'S PHONE:408-515-6551 PHONE NO:(408)496-9960
• LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#690918
Contractor HOLDER INC Date 04/30/2019 X BLDG _ELECT _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:
REPLACE SLIDING GLASS DOOR LIKE FOR LIKE SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION
i. 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
permit is issued. Sq.Ft Floor Area: Valuation:$2250.00
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 county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 357 19 100
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 regulation er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ,, 1 Date 09-22-2017 Issued by:Kim Dunbar
Date:09/22/2017
OWN -BUILDER'DECLARATION
I hereby affirm that I'ani exempt,Crom 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)
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:09-22-2017
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 ands gill maintain a Certificate;of Consent to self-insure for Worker's
Compe'nslation,as provided for by Section 3700 of the Labor Code,for the
performa'n'ce of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
' 2. I have anaiwill maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 31700.of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
•
perniltlis issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify thatlin f the perfor nance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store Or handle hazardous
'q 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
I;, I , i air contaminants as defined by the Bay Area Air Quality Management District I
Worker,.,, ensation;laws of California. If, making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I,'becomesubjectto the Worker's Compensation provisions of the the Health&Safety Code, 'ctions 25505,25533,and 25534.
Labor Code;•l mut forthwith comply'with such provisions or this permit shall //,r�
be deemed revoked. ` ' • Owner or authorized agen "
APPLICANT CERTIFICATION Date:09-22-2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with allicity 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 propertyfor 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: II'1 j I understand my plans shall be used as public records.
Licensed
Signature ' Date 09-22-2017 Professional
CONSTRUCTION PERMIT APPLICATION
/ COMMUNITY DEVELOPMENT DEPARTMENT-• BUILDING DIVISION
V10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
S�.,y� " R.: - 1 38
s (408)777-3228 • building@cupertino.org PEMIT#B-
CUPERTINO REV# ' DEF#'
0 NEW CONSTRUCTION ❑ADDITION hALTERATION ❑T.I. ❑MEP ❑RE-ROOF .❑SWIMMING POOL/SPA
' PROJECT ADDRESS . - APN# I�y
10415 Imperial.Drive 5-T r / D
OWNER NAME PHONE E-MAIL
Sampada Patel ' 408-515-6551 sbpshop@gmail.com •
STREET ADDRESS CITY, STATE,ZIP
❑x CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME - LICENSE NUMBER ' LICENSE TYPE •
Er-1'c IfoC:r,e Hoeor-►c- -0bs),Pc k(,Ie&tArs �o/o. lQ, l3 G-f7
STREE'EADDRESS CITY,STATE, ZIP
zs CO ' A Loo Ave SANP,t cinvtA I LA. S�/
E-MAIL,... PHO BUS.LIC#
r1.0 ea.fote9(sc C.' WOO 76I'/6O0. 22037
•
0 ARCHITECT. 0;OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT El ENGINEER 0 DEVELOPER 0 TENANT I
CONTACT NAME' ' E-MAIL ,
•
STREET:ADDRESS CITY,STATE,ZIP PHONE
DECRI'TON . '
Replace patio door with new patio door like for like in same framed opening.
SINGLE-FAMILI/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL ,
'EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED I.
BATHROOM SF SF SF SF . • 0 DETACHED
EXISING ❑;YES EICHLER 0 YES SECOND STORY ADDESON 0 YES.
FIRE SPRINKLERS 1:1 NO nNO • 0 NO
DWELLING SECOND DWELLING 0 YES 0 ATTACHED❑DETACHED OTHER- ' •
UNITS# UNIT ADDITON:. ❑N0. S F
PO OA ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED ;
POOL-SF SP?.-SF ' I,.SPA ATTACHED DYES ❑NO I TOTAL-SF
'RE :1 TOTAL VALUATION:
Commercial or Multi-Family-Buildings with Public Swimming Pools.requires Department of Environmental Heath approval $2,250.00 ;
•
RE-ROOFt EXISTING ROOF'TYPE: I=1 BUILT-UP ROOF D ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) ;
REMOVE/REPLACE Q NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: :' ' PITCH: ROOF CLASS
0 YES #OF LAYERS THICKNESS❑5/8" OTHER . ❑OSB ❑CDX OTHER' 12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER 1 i I
*Provide a signed copy of the Cupertino's Tear-Off Policy. ., SF Sof 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 stat- aws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection p 4. I acknowledge and authorize all information contained on this application form
to be made available for public record. VAr ;1
Signature of Applicant/Agent: , Date: 17 C-
;