B-2018-0727 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0727
IIIKENTWOOD AVE CUPERTINO,CA 95014-5807(35931004) BDS CONST GROUP
SAN JOSE,CA 95110
OWNER'S NAME: DATE ISSUED:04/30/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#0=79
2779
Contractor BDS CONST GROUP Date 04/30/2020 X BLDG X ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
REMODEL(2)BATHROOMS LIKE FOR LIKE-(75 SF)
1 hereby affirm under penalty of perjury one of the following five declarations: REV#I-KITCHEN REMODEL(90 SF);REPLACE FURNACE-SAME
n. I have and will maintain a certificate of consent to self-insure far Worker's LOCATION;REPLACE FAU IN ATTIC;RE-WIRE WHOLE HOUSE;
Compensation,as provided for by Section 3700 of the Labor Code,for the UPGRADE PANEL(200 AMPS);INSTALL(22)RECESSED LIGHTS
performance of the work for which this permit is issued. THROUGHOUT;RE-ROOF,TEAR-OFF,INSTALL OSB,INSTALL
Section 3700 of the Labor Code,for the performance of the work for which this SHEETROCK-ISSUED 7-20-2018
permit is issued.
Sq.Pt Floor Area; Valuation:$75000.00
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 slate laws relating to building construction,and hereby authorize 359 31 004
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.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Dale 7-20-2018 Issued by:Jasmine Archbold
Date:04/30/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law fmone of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
u I,as owner of the property,or my employees with wages as their sole installed without first c htaining 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. 1,as owner of the property,am exclusively contracting with licensedSignature of Applicant:
coah'actors to construct the project(Sm.7044,Business&Professions Code). Date:7-20-2018
I hereby affirm under penalty ofpm•)ury one of the following three declarations:
t. 1 have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the
per ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the huzu•dous 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 Codc,Sections 25505,25533,and 25534.1 will
permit is issuedfir aintain connpliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance attire work for which this permit is issued,I Health&Safety Code Sacuon 25532(n)should I store at handle hazardous
shall not employ any person in any manner no as to become subject to the material.Additionally,should 1 use equipment o•devices which emit hazardous
Worker's Compensation laws of California.If,atter making this certificate of air contnminnnts as defined by the Bay Area Air Quality Manager ant District 1
exemption,I become subject to the Worker's Cornpensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and
Labor Code,l must forthwith comply with such provisions or this it shall the Health&Safety Code,Sections 25505,25533,and 25534.
p y w' Prov perm
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:7-20-2018
1 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 stale 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. 1 understand my plans shall be used as public records.
Signature Data 7-20-2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0727
1111 KENTWOOD AVE CUPERTINO, CA 95014-5807 (359 31 004) BDS CONST GROUP
SAN JOSE, CA 95110
OWNER'S NAME: Tt Investment Prop LLC DATE ISSUED: 04/30/2018
OWNER'S PHONE: PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #862779
Contractor BDS CONST GROUP Date 04/30/2020 X BLDG X ELECT PLUMB
I hereby affirm.that I am licensed under the provisions of Chapter 9 (commencing X 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:
REMODEL (2) BATHROOMS LIKE FOR LIKE - ( 75 SF)
I hereby affirm under penalty of perjury one of the following two declarations: REV #2 - CHANGE OUT RAFTERS TO MEET 2016 RESIDENTIAL
1. I have and will maintain a certificate of consent to self-insure for Worker's CODE - ISSUED 10-18-2018
Compensation, as provided for by Section 3700 of the Labor Code, for the REV # 1 - KITCHEN REMODEL (90 SF); REPLACE FURNACE - SAME
performance of the work for which this permit is issued. .LOCATION; REPLACE FAU IN ATTIC;.RE-WIRE WHOLE HOUSE;
I have and will maintain Worker's Compensation Insurance, as provided for by UPGRADE PANEL (200 AMPS); INSTALL (22) RECESSED LIGHTS
Section 3700 of the Labor Code, for the performance of the work for which this THROUGHOUT; RE-ROOF, TEAR-OFF, INSTALL OSB, INSTALL
permit is issued. COMP ( 24 SQ); REPAIR FIRE AND TERMITE DAMAGED
APPLICANT CERTIFICATION SHEETROCK -ISSUED 7-20-2018
I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $75000.00
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 APN Number: Occupancy Type:
inspection purposes. (We) agree to save indemnify and keep harmless the 35931 004
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. PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature Date 10-18-2018 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by: Jasmine Archbold
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 04/30/2018
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole RE-ROOFS:
compensation, will do the work, and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed. If a. roof is
sale (See.7044, Business & Professions Code) installed without first obtaining an inspection, I agree to remove all new materials fol-
2. I, as owner of the property, am exclusively contracting with licensed inspection.
. contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date: 10-18-2018
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A". OR BETTER
2. 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 fbr which this HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
3. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Worker's Compensation laws of California, If, after making this certificate of Health &-Safety Code, Section 25532(a) should I store or handle hazardous
exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipment or devices which emit hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I
be deemed revoked. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
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 Owner authorized agent:
relating to building construction, and hereby authorize representatives of this city Date: 10--18-2018
to enter upon .the above mentioned property for inspection purposes. (We) agree � CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.)
judgments, costs, and expenses which may accrue against said City in Lender's Name
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code, Section 9.18.
ARCHITECT'S DECLARATION
Signature Date 10-18-2018 1 understand my plans shall be used as public records.
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0727
1111 KENTWOOD AVE CUPERTINO,CA 95014-5807(359 31 004) BIDS CONST GROUP
SAN JOSE,CA 95110
OWNER'S NAME:IT INVESTMENT PROP LLC DATE ISSUED:04/30/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lie.#$62779 X BLDG ELECT_PLUMB
Contractor BIDS CONST GROUP Dale 04/30/2020 —
I hereby aITirm that Inn licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 offive Business&Professions Code and that my
license is in full force and effect JOB DESCRIPTION:
REMODEL(2)BATHROOMS LIKE FOR LIKE-(75 SF)
I hereby affirm under penalty of perjury one o£the following hire declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ol'the Labor Code,for the
z 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 ofthe Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Elect-Area: Valuation:$15000.00
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 359 31 004
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 012
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.
Signature Date Issued by:Jasmine Archbold
Date:04/30/2018
OWNER-BUILDER DECLARATION
I hereby afth•m that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following taro 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 mspanimn.
sale(Sec.7044,Business&I'mi'essious 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). DoW
1 hereby affirm under penalty of perjury one of the following three declarations: pLL ROOF COVERINGS TO BE CLASS"A"OR BETTOR
1. I have and will maintain a Certificate of Consent to selbinsure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofdre work for which this pewit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materiels 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
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I stare or handle hazardous
shell 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
aI,contaminants as defined by the Bay Are.Air Quality Management District 1
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 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
APPLICANT CERTIFICATION Date:
I certify that I have read this application and state that the above information Is CONSTRUCPION 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 ARCHIT'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureDate Licensed
Professional