B-2019-0460 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0460
10740 RANDY LN CUPERTINO,CA 95014-2055(316 02 073) T Q CONSTRUCTIONS
SAN JOSE,CA 95133
OWNER'S NAME:
PHONE NO:(408)849-1715
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class b Lic.#1007728
Contractor T Q CONSTRUCTIONS Date 09/30/2019 X BLDG _ELECT _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:
NEW 2 STORY SFD(3383 SF),ATTACHED GARAGE(499 SF),PORCH
I he,,reby affirm under penalty of perjury one of the following two declarations: (156 SF),DETACHED ACCESSORY STRUCTURE(400 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -RELOCATE DRIVEWAY TO ACCOMMODATE ELECTRIC
Compensation,as provided for by Section 3700 of the Labor Code,for the POLE-ISSUED 4/22/19
performance of the work for which this permit is issued. DEF# 1 -DEFERRED ROOF TRUSSES-ISSUED 12-5-2018
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:3783 Valuation:$550000.00
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:
316
and state laws relating to building construction,and hereby authorize 316 02 073 R-3(Custom)
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 regulations per thee. upertino icipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature j' Date 4/22/19 Issued by:Kim Dunbar
Date:06/25/2018
OWNER-BUILDER DECLARATION
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)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sce.7044,Business&Professions Code). Date:4/22/19
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. 1 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 perfonnance 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 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 25, 55 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
A
be deemed revoked. Owner or authorized agent:
,.
Date:4/22/19
APPLICANT CERTIFICATION t..r�,...._
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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,
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. I understand my plans shall be used as public records.
Signature Date 4/22/19 Licensed
Professional
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`O N vJ`R1.)CT ION PERMIT APPLICATION
COMMUNITY DEVELOPMEN-1 I_)�a.l.'AT�`TMENrI� # BUILDING DIVISIOI'�
..' -.10300 T4._."1RR.1=', AVENUE * CUPERTI:NO, CA.95014-3255
(408) 777-•3228 * b'U.i1.di.. PERMIT#B-
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,lSKNI GLE-FAMILY/DUPLEX 0 MUI..TI-FAMII.,Y ❑INDUSTRIAL ❑COMMERCIAL,
EXISTING USE FXISTING SI' NEW FLOOR SF PORCH SF DECK SF DE:N;I(_`SI~ S'1ORMS# TOTAL:NETSF USE 'TYPE OC"C SQ..I-T, VALUATION(�)
RENJODEL REMODEL Krl"CHE.N REMODEL(Y'ITiR 1,1RA.GF, ❑ATTA(..HED
BATHROOM SF SF SF SF ❑DETAC:HFD
EXI.SING,, ®YES ®YES SECOND STORY ADDITION ❑SE'S W
FIRE SPRINKLERS® NO EIC'IILeR ® NO
❑NO
DWELLING SECOND DWELLING ❑YES ❑A'7"I"r�CI-IE;I?❑DE'I'.ACI-IED Oil"IAE,I
UNITS# I.NIT ADDITON: ❑NO S F
I10OLS ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑ PREFABRIC'A-T'ED
POOL SF__._ SPA SF SPA ATTACHED ❑YES ❑w^NC3.^ >I01"AL SF
RECEIVE;IL>"`BY: r` TO'N'AL VALUATION:
(:'t?rmnercial or X-fulti-FamilU Buildings ivith Public Swirrinati.,Pt)ols requires Depg.'tinent JEnvironmental Heath czpp.c�vrtl
RE-ROOF EXISTING ROOF`IYPE: BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES[]WOOD SIAINGLI S DILE OTHER SPECIFY
REMOVE/REPLACE❑NO IF NO PLYWOOD '„” � PLYWOOD TYPE: :
❑`/8" PITCHROOF CLASS
YES OF I.yAYEI�S ___ THICKNESS❑S/S„ O'I'}iElz _ �]OS�__[❑CDX OTHER _____��»12 A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF El ASPHALT SHIN(__,LES D WOOD SHAKES 1-1 WOOD SH INGLES OTHER
*Provide a signed copy of the Cupert.ino's Tear-Gaff Policy ST #of SQUARES
By my signature below I certify to each of the following: I ani 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 bL.1ilding construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. I acknowledge and authorize all information contat.ned on this application form
to be made available for public record.
Signat-ure of Applicant/Ag ��.. _ Da te: `::� :':....• ,,..r
SU'PLENIEMTAI.,INFORNIATION ISEQUIRED'i
*Net,v SII?JSecond.Dwelling Units/Multifamily Dwellings:A'Demolit:ion permit is required prier to issuance of a building permit for all neNv construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure farm if any HazardOLIS Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to subt-nittal of Building Permit application.
* TOA-Provide a letter of approval from the Home Owner's Associatiol'i
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