B-2018-0643 CITY 'OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0643
7823 LILAC CT CUPERTINO, CA 95014-4207 (359 03 028) 7825 LILAC CT OWNEWBUILDER
CUPERTINO, CA 95014-4207 (359 03 028)
OWNER'S NAME: DATE ISSUED: 08/17/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic. #
Contractor OWNER/BUILDER Date X BLDG _ ELECT _ 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:
(N) ONE STORY SFD (3049 S.F.); ATTACHED GARAGE (426 S.F.);
I hereby affirm under penalty of perjury one of the following two declarations: COVERED PORCH (58 S.F); DETACHED 2ND UNIT (676 S.F);
1. I have and will maintain a certificate of consent to self-insure for Worker's COVERED PORCH (26 S.F).
Compensation, as provided for by Section 3700 of the Labor Code, for the DEF #1 - TRUSS CALCULATIONS WITH UPDATED ROOF FRAMING
/7performance of the work for which this permit is issued. PLANS (S-5 AND S-6) CONTAINING ADDITIONAL NOTES AND
I have and will maintain Worker's Compensation Insurance, as provided for by DETAILS FOR TRUSS INSTALLATION. - ISSUE 11-19-2018
--''' Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued, Sq. Ft Floor Area: 3725 Valuation: $556220.00
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 APN Number: Occupancy Type:
and state laws relating to building construction, and hereby authorize 35903 028 R-3 (Custom)
representatives of this city to enter upon the above mentioned property for
`,,,.inspecti.o,n 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 180DAYSOF PERMIT ISSUANCE OR
Additioznally, 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,
Sighature°' Date 11/20/18 Issued by: Jasmine Archbold
Date: 08/17/2018
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)
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: 11/20/18
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
3. 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
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, 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 Date: 11/20/18
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 Fending 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. I understand my plans shall be used as public records.
Si nature Date 11/20/18 Licensed
g Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0643
7823 LILAC CT CUPERTINO,CA 95014-4207(359 03 028)7825 LILAC CT APEX DEVELOPMENT
CUPERTINO,CA 95014-4207(359 03 028) GROUP LLC
2059 Camden Ave SAN
JOSE,CA 95124
OWNER'S NAMEt DATE ISSUED:08/17/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class j3 Lic.91033746
Contractor APEX DEVELOPMENT GROUP LLC Date 12/31/2019 X BLDG—ELECT_PLUMB
I hereby affirm that[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:
(N)ONE STORY SFD(3049 SF.);ATTACHED GARAGE(426 S.F.);
I hereby affirm under penalty of perjury one of the following two declarations: COVERED PORCH(58 S.F);DETACHED 2ND UNIT(676 ST);
I I have and will maintain a certificate of consent to self-insure for Worker's COVERED PORCH(26 S.F).
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
1 cation 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft plan Area:3725 Valuation:$556220.00
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 Type:
and state laws relating to building construction,and hereby authorize 35903 028 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 under land and will comply with all non-point
source re�gulati code,section s.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 081171201 8 Issued by:Jasmine Archbold
Date:-084176201-8
OWNER-BUILDER DECLARKFION
I hereby affirm that I am exempt from the Contractor's License Law for one at the RE-ROOFS:
fallowing two reasons: All roofs shall be inspected prior to any roofing conte,ad being installed.If a rout'is
L 1,us 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
campensation,will do the work,and the structure is cot intended or offered to, inspection.
sale(Sec.7044,Business&Professions Code)
z. 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:08/17/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL BOOP COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have rend the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,fat the performance of the work for which this Cnlil'onda Health&Safety Code,Sections 25505,25533,mad 25534.I will
permit is issued. m aintain compliance with the Cupertino Municipal Coda,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I health&Safety Code,Section 25532(x)should I store or handle haznrdors
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
xh.contaminants as defined by the Ray Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with tlt - u' no n'ip 4Code�C, ha ter .12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety
Labor Code,I most forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CER'TIFICA'TION Date:08/1712018
I certify that I have read this application and state that the above information is CONSTRUG ON LENDING AGENCY
correct.I agree to comply with all city and county ordinances and stale 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.)
toenter 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 ARCIfPTCCT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 08/1712018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0643
7823 LILAC CT CUPERTINO, CA 95014-4207 (359 03 028) 7825 LILAC CT APEX DEVELOPMENT
CUPERTINO, CA 95014-4207 (359 03 028) GROUP LLC
2059 Camden Ave SAN
JOSE, CA 95124
OWNER'S NAME: DATE ISSUED: 08/17%2018
OWNER'S PHONE: PHONE NO: (408) 799-6263
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #1033746
Contractor APEX DEVELOPMENT GROUP LLC Date 12/31/2019 X BLDG _ELECT _ 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:
(N) ONE STORY SFD (3049 S.F.); ATTACHED GARAGE (426 S.F.);
I hereby affirm under penalty of perjury one of the following two declarations: COVERED PORCH (58 S.F); DETACHED 2ND UNIT (676 S.F);
1. I have and will maintain a certificate of consent to self-insure for Worker's COVERED PORCH (26 S.F).
Compensation, as provided for by Section 3700 of the Labor Code, for the DEF #1 - TRUSS CALCULATIONS WITH UPDATED ROOF FRAMING
performance of the work for which this permit is issued. PLANS (S-5 AND S-6) CONTAINING ADDITIONAL NOTES AND
I have and will maintain Worker's Compensation Insurance, as provided for by DETAILS FOR TRUSS INSTALLATION. - ISSUE 11-19-2018
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. Sq. Ft Floor Area: 3725 Valuation: $556220.00
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 Type:
and state laws relating to building construction, and hereby authorize 359 03 028 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 regulations per the Cu ertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
,+°� R ,dna' !
Signature Date 11-19-2018 Issued by: Jasmine Archbold
Date: 08/17/2018
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: 11-19-2018
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
3. I certifythat 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, 'ons 255915 533, 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: 11-19-2018 ,
certify that I have read this application and state that the above information is CO ST C TOW LE D G C
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.
Licensed
Signature Date 11-19-2018
Professional