14090182a
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22546 SILVER OAK WAY
CONTRACTOR: SBI BUILDERS INC PERMIT NO: 14090182
OWNER'S NAME: FOOTHILL AUTO SERV & DETAIL INC
1515 THE ALAMEDA STE 300 DATE ISSUED: 01/04/2016
OWNER'S PHONE: 4083994950
SAN JOSE, CA 95132 PHONE NO: (408) 549-1305
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
W9 1
License Class.+
LOT 6 - CONSTRUCT (N) 2 STORY SFD (2232 S.F.) WITH
_ Lic. # _
ATTACHED GARAGE (458 S.F.)
Contractor Ski bi 1�,Ii s "fpc l q
Date �p
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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
Sq. Ft Floor Area:
Valuation: $279000
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.
APN Number: 34232070.22546
Oequpancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
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
WITHIN Igo DAY ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA O CALLED INSPECTION,
indemnify and keep harmless the 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 co.
with all non- oint source regulations per the Cupertino Municipal ode, Section
9.18.
)1 j_
Signature Date
RE -ROOFS:
All roofs shat �insppected o any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
.
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work, and the structure is not intended or offered for sale (Sec, 7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (See.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment. or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 97, and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Stin 25505, 25533, and 25534..
Section 3700 of the Labor Code, for the performance of the work for which this
1
permit is issued.
Owner or authorized agent: Date:
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address - ---
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 relating
to building construction, and hereby authorize 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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 14090182
22546 SILVER OAK WAY (342 32 070)
SBI BUILDERS
1064 ALMARIDA DR
SAN JOSE, CA 95128
OWNER'S NAME: FOOTHILL AUTO SERV & DETAIL INC
DATE ISSUED: 01/04/2016
OWNER'S PHONE:
PHONE NO: 408-2034397
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CONTRACTOR - GENERAL Lic. #860997
Contractor SBI BUILDERS Date 02/29/2016
BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH — 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:
LOT 6 - CONSTRUCT (N) 2 STORY SFD (2232 S.F.) WITH
I hereby affirm under penalty of perjury one of the following two declarations:
ATTACHED GARAGE (458 S.F.)
i. I have and will maintain a certificate of consent to self-insure for Worker's
REV 4 1 -ALL BUILDINGS/OFFICES (140901-72-14090182) - REVISE
Compensation, as provided for by Section 3700 of the Labor Code, for the
CEDAR SIDING TO FIBER CEMENT'- ISSUED 8/11/16
performance of the work for which this permit is issued.
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.
APPLICANT CERITFI ATION
Sq. Ft Floor Area:
Valuation: $279000.00
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 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
342 32 070
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
PERMIT EXPIRES IF WORD IS NOT STARTED
source regulations per the Cupertin dvlunicipal Code, section 9.18.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FRONT T A INSPECTION.
Signature Date
OWNER-BUILDERDECLARATION
Issued by: Y.
Date: 01/04/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
r. 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 (Sec.7044, Business & ProfessionsCode)
installed without first obtaining an inspection, I agree to remove all new materials for
z. I, as owner of the property, am exclusively contracting with licensed
inspection.
contractors to construct the project (Sec.7044, Business & Professions Code).
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations:
Date:
r. 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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
performance of the work for which this permit is issued.
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 for which this
HAZARDOUS MATERIALS DISCLOSURE
permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
s. 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, atter making this certificate of
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
exemption, I become subject to the Worker's Compensation provisions of the
air contaminants as defined by the Bay Area Air Quality Management District I
Labor Code, I must forthwith comply with such provisions or this permit shall
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
be deemed revoked.
the Health & Safety Code, Sections 25505, 25533, and 25534.
APPLICANT CERTIFICATION
-l
L
I certify that I have read this application and state that the above information is
Owner or authorized agent.. ' 1 4
correct. I agree to comply with all city and county ordinances and state laws
Date:
relating to building construction, and hereby authorize representatives of this city
ONSTR CTI N LE NDING AGENCY
to enter upon the above mentioned property for inspection purposes. (We) agree
1 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
I understand my plans shall be used as public records.
Signature Date
Licensed