B-2018-1089 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1089
1495 ASTER LN CUPERTINO,CA 95014-5217(366 24 005) OWNER/BUILDER
OWNER'S NAME: DATE ISSUED: 11/08/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor OWNER/BUILDER Date X BLDG X ELECT —PLUMB
X 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:
ADDITION OF FRONT BEDROOM(472 SF)AND FRONT PORCH
I hereby affirm under penalty of perjury one of the following two declarations: ( 100 SF);REMODEL HALLWAY BATHROOM(40 SF);REMODEL
1. I have and will maintain a certificate of consent to self-insure for Worker's OTHER(306 SF);RELOCATE FURNACE;RE-ROOF EXISTING
Compensation,as provided for by Section 3700 of the Labor Code,for the AREAS,TEAR-OFF,INSTALL OSB,INSTALL COMP SHINGLES-(22
performance of the work for which this permit is issued. SQ);UPGRADE PANEL(200 AMPS)-SAME LOCATION
I have and will maintain Worker's Compensation Insurance,as provided for—Vb?J
#1 -REVISE DETAIL#1 ON S3;REMOVE FIREPLACES IN
Section 3700 of the Labor Code for theerformance of the work for which t
p � MASTER BEDROOM AND FROM BEDROOM;EXISTING MAIN
permit is issued. PANEL TO REMAIN(100 AMP)-ISSUE 7/2/19
APPLICANT CERTIFICATION Sq.Ft Floor Area:472 Valuation:$90000.00
1 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 APN Number: Occupancy Type:
representatives of this city to enter upon the above mentioned property for 366 24 005 R-3(Custom)
inspection purposes. (We)agree to save 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. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all non point
source regulations per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signa4 Date 7/2/19
Issued by:Haley McKee
OWNER-BUILDER DECLARATION Date: 11/08/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
1,
as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) inspection.
I,as owner of the property,am exclusively contracting with licensed
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:7/2/19
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.
I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
�. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the Health&Safety Code,Section 25532(a)should I store or handle hazardous
Worker's Compensation laws of California. If,after making this certificate of 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
I certify that I have read this application and state that the above information is Date:7/2/19
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We)agree
of work's for which this permit is issued(Sec.3097,Civ C.)
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
judgments,costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section .
I understand my plans shall be used as public records.
Signature � Date 7/2/19
NJ Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1089
1495 ASTER LN CUPERTINO, CA 95014-5217 (366 24 005)
OWNER'S NAME: DATE ISSUED: 11/08/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic. #
Contractor Date 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:
ADDITION OF FRONT BEDROOM( 472 SF) AND FRONT PORCH
I hereby affirm under penalty of perjury one of the following two declarations: ( 100 SF); REMODEL HALLWAY BATHROOM ( 40 SF ); REMODEL
1. I have and will maintain a certificate of consent to self-insure for Worker's OTHER ( 306 SF); RELOCATE FURNACE; RE-ROOF EXISTING
Compensation, as provided for by Section 3700 of the Labor Code, for the ,AREAS, TEAR-OFF, INSTALL OSB, INSTALL COMP SHINGLES - (22
performance of the work for which this permit is issued. SQ); UPGRADE PANEL (200 AMPS)-SAME LOCATION
2. I have and will maintain Workers 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: 472 Valuation: $90000.00
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 66 Number: Occupancy Type:
and state laws relating to building construction, and hereby au3
authorize
366 24 005 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 OFPE
Additionally, the applicant understands and will comply with all non-point RIT
ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED -INSPECTION.
Signature Date 11/812018 Issued by: Haley McKee
Date: 11/08/2018
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
�. 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.
p � >
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: 11/8/2018.
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. I 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 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
_ 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.
p p 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
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, Sectio)" 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 Date: 11/8/2018
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. 1 understand my plans shall be used as public records.
Signature � � /_ �-��'�"`��'"""`� Date 11/8/2018 Licensed
Professional