B-2018-0340 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0340
10128 STERN AVE CUPERTINO,CA 95014-3667(375 12 009) GRAND-NEST
CONSTRUCTION
SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED:05/11/2018
OWNER'S PI4ONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#965419
Contractor GRAND-NEST CONSTRUCTION Date 09/3012019 X BLDG_ELECT_PLUMB
1 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 SINGLE LEVEL SFD-(2432 SF),ATTACHED GARAGE(468 SF),
I hereby affirm under penalty of perjury one of the following two declarations: PORCH(62 SF)
t. 1 have and will maintain a certificate of consent to self-insure for Workei's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
� have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perforro nee of the work for which this
permit is issued. Sq.Ft Flour Area:2432 Valuation:$400000.00
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'rypn:
and state laws relating to building construction,and hereby authorize 375 12 009 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 WORT{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.
Signature `� Data 05 1118 Issued by:SEAN HATCH
Date:05/1 l/2018
OWNER-
I hereby affirm that I.,it exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to ally roofing material being installed.Ifs roof is
u 1,as owner of the property,or my employees with wages as their sole instilled 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(Sce.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05.1 L 18
1 hereby affirm mhder penalty or perju y one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr. I have and will maintain a Certificate of Consent to self-Insure Por 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazm dous canterials regnirenients 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,-1 25534.I will
permit
is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issuedHealth&Safety Cade,Section 25532(x)should I store or handle hazardous,I material.Additional!
shall not employ any persue in any manner so as to become subject to the y,should 1 use e quipmant n devQuality which emit Management Disvdous
nir eonintain cosas pldefinedh the Bayrtin Air Qualityod,ChaptBiatrial
Worker's Compensation laws of California.If,after making ihisoertificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,t 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
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data:05.11.18
I certify that I have read this application and state that the above information is CONSTRUCT IOY 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. 1 understand my plans shall be used as public records.
SignatureLicensed
Data 05,11 18
Professional