HomeMy WebLinkAboutB-2018-0858 PermitCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0858
10222 BARBARA LN CUPERTINO, CA 95014-2902 (359 12 020)
C & D FREITAS
CONSTRUCTION INC
SANTA CRUZ, CA
95060
`
OWNER'S NAME:
DATE ISSUED: 10/26/2018
OWNER'S PHONE:
PHONE NO: (408) 353-1900
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #286517
Contractor C & D FREITAS CONSTRUCTION INC Date 01/31/2020
X BLDG —ELECT X PLUMB
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 FIRST FLOOR -LIVING RM & KITCHEN (236 SF) EXTEND
I hereby affirm under penalty of perjury one of the following two declarations:
FRONT DOOR (50 SF); KITCHEN REMODEL (192 SF); BATH
1. I have and will maintain a certificate of consent to self -insure for Worker's
REMODEL COVERT TO 2 BATHS & MASTER BATH REMODEL (161
Compensation, as provided for by Section 3700 of the Labor Code, for the
SF); (2) NEW TANK -LESS WATER HEATER SAME LOCATION, 3-
of the work for which this permit is issued.
NEW SKYLIGHTS
,,�Vperformance
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
Sq. Ft Floor Area:
Valuation: $71000.00
permit is issued.
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 12 020
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 OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regul Lionsrppeer the rtino Municipal Code, Section 1 8.
9
Issued b : Phuon Devries
Y t;
Date: 10/26/2018
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
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
inspection.
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:
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. 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
3. 1 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
shall 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
air contaminants as defined by the Bay Area Air ality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance wit Cuperti o Municip Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & S ety Co , Sec o 55d5 33, and 255534.
_ (
/
I certify that I have read this application and state that the above information is 40
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
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0858
10222 BARBARA LN CUPERTINO, CA 95014-2902 (359 12 020) C & D FREITAS
CONSTRUCTION INC
SANTA CRUZ, CA
95060
OWNER'S NAME:
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #286517
Contractor C & D FREITAS CONSTRUCTION INC Date 01/31/2020
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:
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.
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 CERTIFICATION
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 Section 9.18.
Signature> Date 03/18/2019
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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 or offered for
sale (Sec.7044, Business & Professions Code)
2. I, 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:
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.
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
permit is issued.
I certify that in the performance of the work for which this pen -nit 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
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.
Signature
Date 03/18/2019
DATE ISSUED: 10/26/2018
PHONE NO: (408) 353-1900
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
ADDITION FIRST FLOOR -LIVING RM & KITCHEN (236 SF) EXTEND
FRONT DOOR (50 SF); KITCHEN REMODEL (192 SF); BATH
REMODEL COVERT TO 2 BATHS & MASTER BATH REMODEL (161
SF); (2) NEW TANK -LESS WATER HEATER SAME LOCATION; 3-
NEW SKYLIGHTS
REV # 1 - REVISE STRUCTURAL AND ARCHITECTURAL CHANGES
TO (2) BATHROOMS; RELOCATE THE DOOR FROM HOUSE TO
GARAGE; ADJUST FOUNDATION TO ADDITION DUE TO THE
EXISTING GRADE - ISSUED 03/18/2019
Sq. Ft Floor Area: I Valuation: $71000.00
APN Number: Occupancy Type:
359 12 020 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Phuong Devries
Date: 10/26/2018
RE -ROOFS:
All roofs shall be inspected prior to any rooting material being installed. if a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 03/18/2019
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I 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
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date: 03/18/2019
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.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0858
10222 BARBARA LN CUPERTINO, CA 95014-2902 (359 12 020)
C & D FREITAS
CONSTRUCTION INC
SANTA CRUZ, CA
95060
OWNER'S NAME:
DATE ISSUED: 10/26/2018
OWNER'S PHONE:
PHONE NO: (408) 353-1900
LICENSED CONTRACTOR'S DECLARATION
BUILDING -PERMIT INFO:
License Class B Lic. #286517
Contractor.0 & D FREITAS CONSTRUCTION INC Date 01/31/2020
X BLDG —ELECT X PLUMB
I 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:
ADDITION FIRST FLOOR -LIVING RM &KITCHEN (236 SF) EXTENDFRONT
I hereby affirm under penalty of perjury one of the following two declarations:
DOOR (50 SF); KITCHEN REMODEL (192 SF); BATH
1. I have and will maintain a certificate of consent to self -insure for Worker's
REMODEL COVERT TO 2 BATHS &MASTER BATH REMODEL (161
Compensation, as provided for by Section 3700 of the Labor Code, for the
SF); (2) NEW TANK -LESS WATER HEATER SAME LOCATION; 3-
performance of the work for which this permit is issued.
NEW SKYLIGHTS
I have and will maintain Worker's Compensation Insurance, as provided for by
REV # 2 - REVISE MASTER BATH LAYOUT - ISSUED 5/20/19
Section 3700 of the Labor Code, for the performance of the work for which this
REV # 1 - REVISE STRUCTURAL AND ARCHITECTURAL CHANGES
permit is issued.
TO (2) BATHROOMS; RELOCATE THE DOOR FROM HOUSE TO
APPLICANT CERTIFICATION
GARAGE; ADJUST FOUNDATION TO ADDITION DUE TO THE
I certify that I have read this application and state that the above
EXISTING GRADE - ISSUED 03/18/2019
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
Sq. Ft Floor Area:
Valuation: $71000.00
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
APN Numb
Number:
Oe•
Occupancy y Type:
may accrue against said City in consequence of the granting of this permit.
359 12 020
R-3 (Custom)
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
�`
Signature ;.---- .� �� Date 5/20/19
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Issued by: Phuong Devries
following two reasons:
Date: 10/26/2018
1. 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 or offered for
sale (Sec.7044, Business & Professions Code)
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
2. I, as owner of the property, am exclusively contracting with licensed
installed without first obtaining an inspection, I agree to remove all new materials for
contractors to construct the project (Sec.7044, Business & Professions Code).
inspection.
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Signature of Applicant:
Compensation, as provided for by Section 3700 of the Labor Code, for the
Date: 5/20/19
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
Worker's Corpensation laws of California. If, after making this certificate of
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
exemption, I become subject to the Worker's Compensation provisions of the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall
material. Additionally, should I use equipment or devices which emit hazardous
be deemed revoked.
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
APPLICANT CERTIFICATION
the Health & Safety Code, Sections 25505, 25533, and 25534.
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 representatives of this city
Owner or authorized agent: ==_'
to enter upon the above mentioned property for inspection purposes. (We) agree
Date: 5/20/19
to save indemnify and keep harmless the City of Cupertino against liabilities,
CONSTRUCTION LENDING AGENCY
judgments, costs, and expenses which may accrue against said City in
I hereby affirm that there is a construction lendin agency for the erformance
g g y p
consequence of the granting of this permit. Additionally, the applicant understands '
of work's for which this permit is issued (Sec. 3097, Civ C.)
and will comply with all non -point source regulations per the Cupertino Municipal
Lender's Name
Code, Section 9.18.
Lender's Address
Signature Date 5/20/19
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.