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HomeMy WebLinkAboutB-2018-0178CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0178 7653 NOR-MANDY WAY CUPERTINO, CA 95014-5252 (366 11 163) CABALLERO'S CONSTRUCTION SAN JOSE, CA 95122 jOWNER'SNAME: I IDATE ISSUED: 05/02/2018 I OWNER'S PHONE: 1 1PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION License Class B Lie. #25AaEZ Contractor CABALLERO'S CONSTRUCTION Date 06/30/2019 I hereby aftirm 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. hereby affirm under penalty of perjury one of the following two declarations: t. 1 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 hawperformancewill the warn for which this permit is issued. I haw and will maintain Worker's Compensation Insurance, as provided for by Section 3700 or the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above nformation is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize epresentatives of this city to enter upon the above mentioned property for nspectlon purposes. (We) agree to save indemnify and keep harmless the 'Ity of Cupertino against liabilities, judgments, costs, and expenses which nay accrue against said City in consequence of the granting of this permit. \dditionally, the ap Ilcanl understands and will comply with all non -point source regulations �ier the Cupertino Municipal Code, Section 9.18. 06/0512018 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered For sale (Sec.7044, Business & Professions Code) 2. f, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: r. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 o£dre Labor Code, for the performance, of the work for which this permit is issued. 2. 1 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. s. I certify that in the performance of the work for which this permit is issued, 1 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 become subject to the Worker's Compensation provisions of the Labor Cade, I must forthwith comply with such provisions or this permit shall be deemed revoked, 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 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, 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. Date 06/05/2018 BUILDING PERMIT INFO: BLDG ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FIRST/SECOND FLOOR REMODEL (2047 SF); KITCHEN (200 SF), 4- BATHROOMS REMODEL (260 SF), CONVERT GARAGE TO MUD ROOM (24 SF); REMOVE DECK (107 SF); GARAGE RE -ROOF - (50 SQ); CHANGE GARAGE DOOR REV # I RELOCATE HARDY PANEL; ADD TO EXISTING BEAM - ISSUED 6/5/2018 Sq. Ft Floor Area: I Valuntion: $350000.00 APN Number: Occupancy Type: 366 11 163 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Jasmine Archbold RE -ROOFS, All roofs shall be inspected prior to any roofing material being installed If a roof is installed without first obtaining an inspection, I agree to remove all new mate,nds for inspection, HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements coder Chapter 6.95 of the Cnllfarnta Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the C tpertino Municipal Cade, Clmpter 9.12 and the Health & Safety Code, ections 25505, 25533, and 25534. Owner or authorized agent: Date: 06105/2018 ' I G AGENCY hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name ender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-201&0178 7653 NORMANDY WAY CUPERTINO, CA 95014-5252 (366 11 163) CABALLEROS NAME: PHONE: LICENSED CONTRACTOR'S DECLARATION Class @ Lie, #9843a7 lot CABALLERO'S CONSTRUCTION Date 06/30/2019 hereby affirm that I am licensed under the provisions of Chapter 9(commencing pith Section 7000) of Division 3 of the Business & Professions Code and that my tense is in fall force and effect. I hereby affirm under penalty of perjury one of the following two declarations: r. I have and will maintain a certificate of consent to self-insum for Worker's nk Compensation, as provided For by Section 3700 of the Labor Code, for the ,fK performance of the work for which this permit is issued. C/ I have and will maintain Worker's Compensation Insurance, as to for by ( Section 3700 of the Labor Code, for the performance of the work for which this Pei mit is issued. 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, 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 thg Cupertino Municipal Code, Section 9.18. Signature -- / Date 05102/2018 OWNER -BUILDER DECLARATIO I hereby affirm that I am exempt train the Contractor's License Law for one of the fallowing two reasons: s. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended ar offered for sale (Sec.7044, Business & Professions Code) Z. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code), 1 hereby affirm under penalty of perjury one of the following three declarations: r. 1 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Cade, for the performance of the work for which [his permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manna so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked, APPLICANT CERTIFICATION I certify that I have read this application and slate 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, 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 9A8. Date 05/02/2018 ,N JOSE, CA 95122 DATE ISSUED: 05/02/2018 PHONE NO: (408) 394-0023 JILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: T/SECOND FLOOR REMODEL (2047 SF); KITCHEN (200 SF), 4- 4ROOMS REMODEL (260 SF), CONVERT GARAGE TO MUD M (24 SF); REMOVE DECI{ (107 SF); GARAGE RE -ROOF - (50 CHANGE GARAGE DOOR Ft FIDor Area: I Valuation:$350000.00 I Number: 11 163 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Archbold RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature d£Appliumin Date: 05/02/2018 HAZARDOUS MATERIALS DISCLOSURE I have rend the hazardous mount his requirements under Chapter 6,95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safely Code, Section 25532(a) should I stare m- handle hazardous ❑ aterial. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Aran Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Cod Sections 5505, 25533, quit 25534. Owner or authorized agent: Date: OW212018 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0178 7653 NORMANDY WAY CUPERTINO, CA 95014-5252 (366 11 163) CABALLERO'S CONSTRUCTION SAN JOSE, CA 95122 OWNER'S NAME: DATE ISSUED: 05/02/2018 OWNER'S PHONE: PHONE NO: (408) 394-0023 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #984387 Contractor CABALLERO'S CONSTRUCTION Date 06/30/2019 X BLDG —ELECT —PLUMB MECH X RESIDENTIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: FIRST/SECOND FLOOR REMODEL (2047 SF); KITCHEN (200 SF), 4- I have and will maintain Worker's Compensation Insurance, as provided for by ISSUED 6/5/2018 Section 3700 of the Labor Code, for the performance of the work for which this REV # 2 - CHANGE PANTRY FOR KITCHEN; CHANGE WALL AND permit is issued. RAIL ON 2ND FLOOR - ISSUED 4/26/19 APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $350000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for 366 11 163 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 = Date 4/26/19 Issued by: Jasmine Archbold OWNER -BUILDER DECLARATION Date: 05/02/2018 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 1. 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. 2. 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: 4/26/19 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 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 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 3. 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 Code, Sections 25505, 25533, and 25534. APPLICANT CERTIFICATION Owner or authorized agent: certify that I have read this application and state that the above information is Date: 4/26/19 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 9.18. ARCHITECT'S DECLARATION understand my plans shall be used as public records. Signature Date 4/26/19 Licensed Professional NO FEE FOR RECORDING PURSUANT TO GOVERNMENT CODE SECTION 27383 When Recorded Mail To: City of Cupertino Community Development Department 10300 Torre Avenue Cupertino, CA 95014 ll LLouJ»L ILdILI1 IL IL v.-v V V 1 V 01�1�➢y o Owner's Signature Print Owner's Name 116I�}� z Date CITY AUTHORIZATION: ON: 9& lo-wAJ Erika Poveda, Assistant Planner 24156651 Regina Aloomendras Santa Clara County - Clerk -Recorder 04/16/2019 12:37 PM `ides: I Pages: 3 Fees: 10.00 0.00 Taxes: 0 Tolll FAC 0WFI ®41i1%111 011 if, A11.1A 11111 Date �C ° qq ! � i y :i A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Santa Clara before me Kirsten Squareia 9 Notary Public, (Here insert name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence to be the personKwhose name(4 is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityf ie's), and that by his/her/their signature on the instrument the persoWs , or the entity upon,behalf of which the persono acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. °F > Kif Sf EN kLJXR6 WITNESS m hand and official seal. Natary Publu California z y Santa Clara County > N Commission # 2257322 `""`°" My, Comm, ExpiresActA 2022 Sig4fture of Notary Public (Notary Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING TH15 FORM DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) Attorney -in -Fact ❑ Trustee(s) ❑ Other Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such`a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). 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If`seal.impression s iudges, re -seal if a sufficient area permits, otherwise complete a differentacknowledgmentform. o Signature of the notary public must match the signature on file with, the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). o Securely attach this document to the signed document, C 2004-2015 ProLink Signing Service, Inc. — All Rights Reserved: www.TheProLink.com -Nationwide Notary Service A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of & UaKQ OnMO U A before me, ]LAURIEA, (LOVE ]LOVINSKY, NOTARY PUBLIC (here insert name and title of the officer) personally appeared Rom, — Odush hta Gn K�� a who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is are ubscribe the within instrument and acknowledged to e that he/she the�q, executed the same -in -his/her their authorized capacity(ies), and that by his/her heir ignature(s) on instrument the person(s), or the entity upon behalf of which the person(s) acted, exe ed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoingparagraph is true and correct. WITNESS my hand and official seal. Signature LAUE@L LOVE LOMSKY ,- GOMM. #2234�771 z Notary Public California o' Z � Santa Clara County a .,FowN My Comm. Expires Mar, 18, 2022 (Seal) Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of _,. 0d�`�� pp �� (r Q J containing pages, and dated `ter/d 4 z® Q The signer(s) capacity or authority is/are as: ❑ Individual(s) ❑ Attorney -in -Fact ❑ Corporate Officer(s) ❑ Guardian/Conservator ❑ Partner-Limited/General ❑ Trustee(s) ❑ Other: representing: Title(s) Name(s) of Person(s) or Entity(ies) Signer is Representing Method of Signer Identification Proved to me on the basis of satisfactory evidence: Q form(s) of identification Q credible witness(es) Notarial event is detailed in notaryjournal on: Page # Entry # Notary contact: Other ❑ Additional Signer(s) ❑ Signer(s) Thumbprint(s) O Copyright2007-2017 Notary Rotary; PO Box 41400, Des Moines, IA 50311-0507. All Rights Reserved. Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form.