B-2017-0420 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0420
10240 STERN AVE CUPERTINO, CA 95014-3689 (375 12 042) ABLE PAINTING &
CONSTRUCTION CO
FREMONT, CA 94555
OWNER'S NAME: DATE ISSUED: 03/14/2017
OWNER'S PHONE: PHONE NO: (510) 414-7533
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B. C33 Lic. #594438
Contractor ABLE PAINTING & .CONSTRUCTION CO Date 05/31/2018 X BLDG X ELECT X 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:
REMODEL KITCHEN (63 SF); (N) BATHROOM (43 SF)/LAUNDRY
I hereby affirm under penalty of perjury one of the following two declamations: ROOM (18 SF); NEW SUB PANEL (50 AMP)
1. I have and will maintain a certificate .of consent to self-insure for Worker's REV#2 - REPLACE FURNACE AND WATER HEATER (SAME
Compensation, as provided for by Section 3700 of the Labor Code, for the LOCATION), BEDROOM 3 REPLACE CEILING DRYWALL (206 SF),
performance of the work for which this permit is issued. UPGRADE PANEL (200 AMPS), BATH R.EMODEL(60 SF), REPLACE
2, I have and will maintain Worker's Compensation Insurance, as provided for by (1) WINDOW TO MEET EGRESS- ISSUED 10/15/2018
, Section 3700 of the Labor Code, for the performance of the work for which this REV #1 - LOCATION CHANGE OF BATHROOM ADDITION,
permit is issued. LAUNDRY ROOM, AND SIDE ENTRY DOOR; ADD ONE WINDOW IN
APPLICANT CERTIFICATION BATHROOM ADDITION - ISSUED 7/13/2018
certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $50000.00
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 375 12 042
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. PERMIT EXPIRES IF WORD IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature Date 10/15/2018 180 DAYS FROM LAST CALLED INSPECTION.
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OWNER-BUILDER DECLARATION Issued by: Kim Dunbar
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 03/14/2017 _
following two reasons:
1, 1, 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 & Professions Code) 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),
I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date: 10/15/2018
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
3. 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, after making this certificate of Health & Safety Code, Section 25532(a) should I store or handle hazardous
exemption, I become subject to the Worker's Compensation provisions of the material. Additionally; should I use equipment or devices which emit hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I
be deemed revoked, will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is Owner or authorized agent: -�
correct. I agree to comply with all city and county ordinances and state laws Date: 10/15/2018
relating to building construction, and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY
to enter upon the above mentioned property for inspection purposes. (We) agree I 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 ,
consequence of the granting of this permit. Additionally, the applicant understands Lenders Name
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code, Section 9.18.
ARCHITECT'S DECLARATION
Signature Date 10/15/2018 1 understand my plans shall be used as public records.
Licensed