B-2018-1271 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1271
19482 ROSEMARIE PL APT 3 CUPERTINO,CA 95014-3462(375 01 003)19482 XANADU
ROSEMARIE PL APT 2 CUPERTINO,CA 95014-3462(375 01 003)119482 CONSTRUCTION INC
ROSEMARIE PL APT 4 CUPERTINO,CA 95014-3462(375 01 003)119482 SARATOGA,CA 95070
ROSEMARIE PL APT 1 CUPERTINO,CA 95014-3462(375 01 003)
OWNER'S NAME: DATE ISSUED:08/01/2018
OWNER'S PHONE: PHONE NO:(408)892-8402
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#949373
Contractor XANADU CONSTRUCTION INC Date 06/30/2020 X BLDG X 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:
REV#1-REMODEL BATHROOM IN APT 1 (50 SF);ADD(14)
I hereby affirm under penalty of perjury one of the following two declarations: RECESSED LIGHTS INBEDROOM/LAUNDRY;
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL POWDER ROOM AND ADD LAUNDRY IN.APT 2(3 0 SF);
' Compensation,as provided for by Section 3700 of the Labor Code,for the ADD(N)CLEAN OUT-ISSUED 11/06/2018
performance of the work for which this permit is issued. REV#2-APT#3-REMODEL(2)BATHROOMS(88 SF);REMODEL
have and will maintain Worker's Compensation Insurance,as provided for by KITCHEN(85 SF);(N)SUB-PANEL(125 AMP)-ISSUED 2/12/19
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. REMODEL(2)KITCHEN FOR APT 1&APT 2-( 183 SF COMBINED);
APPLICANT CERTIFICATION REMODEL(2)BATHROOMS FOR APT 2;
1 certify that I have read this application and state that the above REPLACE(2)SUBPANELS IN APT 1 &2(75 AMPS)
information is correct.I agree to comply with all city and county ordinances INSTALL(9)RECESSED.LIGHTS IN APT 2
and state laws relating to building construction,and hereby authorize REPLACE(18)WINDOWS LIKE FOR LIKE TO MEET EGRESS AND
representatives of this city to enter upon the above mentioned property for REPLACE(5)DOORS IN APTS 1,2,3,4
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which Sq.Ft Floor Area: Valuation:$90000.00
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. APN Number: Occupancy Type:
375 01 003
Signature Date 2/12/19
PERMIT EXPIRES IF WORK IS NOT STARTED
OWNER-BUILDER DECLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I hereby affirm that I am exempt from the Contractor's License Law for one of the 180 DAYS FROM LAST CALLED INSPECTION,
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 Issued by:Jasmine Archbold
sale(Sec.7044,Business&Professions Code) Date:08/01/2018
2. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). RE-ROOFS:
I hereby affirm under penalty of perjury one of the following three declarations: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I have and will maintain a Certificate of Consent to self-insure for Worker's installed without first obtaining an inspection,I agree to remove all new materials for
Compensation,as provided for by Section 3700 of the Labor Code,for the inspection.
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by Signature of Applicant:
Section 3700 of the Labor Code,for the performance of the work for which this Date:2/12/19
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
exemption,I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the
Labor Code,I must forthwith comply with such provisions or this permit shall California Health&Safety Code,Sections 25505,25533,and 25534. I will
be deemed revoked. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
APPLICANT CERTIFICATION Health&Safety Code,Section 25532(a)should I store or handle hazardous
I certify that I have read this application and state that the above information is material. Additionally,should I use equipment or devices which emit hazardous
correct.I agree to comply with all city and county ordinances and state laws air contaminants as defined by the Bay Area Air Quality Management District I
relating to building construction,and hereby authorize representatives of this city will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
to enter upon the above mentioned property for inspection purposes. (We)agree the Health&Safety Code,5kctions 25505,25533,and 25534.
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Owner or authorized agent:
consequence of the granting of this permit. Additionally,the applicant understands Date:2/12/19
and will comply with all non-point source regulations per the Cupertino Municipal CONSTRUCTION LENDING AGENCY
Code,Section 9.18. 1 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
Signature Date 2/12/19
Lender's Address
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:9-2018-1271
19482 ROSEMARIE PL APT 4 CUPERTINO,CA 95014-3462(375 01 003)119482 XANADU
ROSEMARIE PL APT 3 CUPERTINO,CA 95014-3462(375 01 003)119482 CONSTRUCTION INC
ROSEMARE PL APT 2 CUPERTINO,CA 95014-3462(375 01 003)19482 SARATOGA,CA 95070
ROSEMARIE PL APT I CUPERTINO,CA 95014-3462(375 01 003)
OWNER'S NAME:
PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#949373
Contractor XANADU CONSTRUCTION INC Date 08/30/2020 2 BLDG X ELECT—PLUMB
1 hereby affirm that 1 nm 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:
REMODEL(2)KITCHEN FOR APT 1&APT 2-(183 SF COMBINED);
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL(2)BATHROOMS FOR APT 2;
n. I have and will maintain a certificate of consent to self-insure for Worker's REPLACE(2)SUBPANELS IN APT I&2(75 AMPS)
Compensation,as provided for by Section 3700 of the Labor Code,for the INSTALL(9)RECESSED LIGHTS IN APT 2
performance of the work for which this permit is issued. REPLACE(18)WINDOWS LIKE FOR LIKE TO MEET EGRESS AND
I have and will maintain Wet her's Compensation Insurance,as provided for by REPLACE(5)DOORS IN APTS I,2,3,4
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Arca: Valuation:$80000.00
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 375 01 003
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 Iiabilitles,judgments,costs,and expenses which PERMIT EXPIRES IF WORI{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
Data 08/01/2018 Issued by:Jasmine Archbold
Date:08/01/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt front the Contractor's License Law I'or are of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sce.7044,Business&Professions Code)
z. t,as owner of the property,am exclusively contracting with licensed Signature oPApplicanC
contractors to construct the project(See.7044,Business&Professions Code). Data:08/0.1/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 have and will nmintaie a Certificate of Consent to setf-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
e 1 have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 or 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.f will
permit is issued. mainnin compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I can tify that in the performance of the work for which this permit is Issued,I Health&Safety Code,Seaton 25532(a)should 1 store or handle huxtu•dous
shill not employ any person io any naanoer so as to become subject to the anterial.Additionally,should 1 use equipment ar devices which emit huzardoas
air contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.II',after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,1 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
APPLICANT CERTI FICATION Date:08/0112018
1 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 sold 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 ARCHI'FEC'I"S DF,CLA RATION
Code,Suellen 9,18. 1 understand my plans shall be used as public records.
Signature Date 08/01!2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1271
19482 ROSEMARIE PLAPT 3 CUPERTINO, CA 95014-3462 (375 01 003)119482 XANADU
ROSEMARIE PL APT 2 CUPERTINO, CA 95014-3462 (375 01 003) 19482 CONSTRUCTION INC
ROSEMARIE PL APT 4 CUPERTINO, CA 95014-3462 (375 01 003)119482 SARATOGA, CA 95070
ROSEMARIE PL APT 1 CUPERTINO, CA 95014-3462 (3 75 01 003)
OWNER'S NAME: DATE ISSUED: 08/01/2018
OWNER'S PHONE: PHONE NO: (408) 892-8402
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #949373
Contractor XANADU CONSTRUCTION INC Date _06/30/2020 X BLDG X 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:
REV # 1 - REMODEL BATHROOM IN APT 1 (50 SF); ADD (14)
I hereby affirm under penalty of perjury one of the following two declarations: RECESSED LIGHTS IN BEDROOM/LAUNDRY;
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL POWDER ROOM AND ADD LAUNDRY IN APT 2 (30 SF);
Compensation, as provided for by Section 3700 of the Labor Code, for the ADD (N) CLEAN OUT - ISSUED 11/06/2018
performance of the work for which this permit is issued.
?. I have and will maintain Worker's Compensation Insurance, as provided for by REMODEL (2) KITCHEN FOR APT 1 & APT 2 - ( 183 SF COMBINED);
Section 3700 of the Labor Code, for the performance of the work for which this REMODEL (2) BATHROOMS FOR APT 2;
permit is issued.- REPLACE (2) SUBPANELS IN APT 1 & 2 (75 AMPS)
APPLICANT CERTIFICATION INSTALL (9) RECESSED LIGHTS IN APT 2
1 certify that I have read this application and state that the above REPLACE (18) WINDOWS LIKE FOR LIKE TO MEET EGRESS AND
information is correct. I agree to comply with all city and county ordinances REPLACE (5) DOORS IN APTS 1, 21 314
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for Sq. Ft Floor Area: Valuation: $90000.00
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. APN Number: Occupancy Type:
Additionally, the applicant understands and will comply with all non-point 375 01 003
source regulations per the Cupertino Municipal Code, Section 9. 18.
PERMIT EXPIRES IF WORK IS NOT STARTED
Signature Date 11/06/2018WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: Issued by: Jasmine Archbold
1. I, as owner of the property, or my employees with wages as their sole Date: 08/01/2018
compensation, will do the work,*and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code) RE-ROOFS:
2. 1, as owner of the property, am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed. If a roof is
contractors to construct the project (Sec.7044, Business & Professions Code). installed without first obtaining an inspection, I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations: inspection.
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 Signature of Applicant:
performance of the work for which this permit is issued. , Date: 11/06/2018
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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
Worker's Compensation laws of California, If, after making this certificate of California Health & Safety Code, Sections 25505, 25533, and 25534. I will
exemption, I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous
be deemed revolted, material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health & Safety Code, ections 25505, 25533, and 25534.
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 Owner or authorized agent:
to save indemnify and keep harmless the City of Cupertino against liabilities, Date: 11/06/2018
judgments, costs, and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY
consequence of the granting of this permit. Additionally, the applicant understands I hereby affirm that there is a construction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued (Sec. 3097, Civ C.)
Code, Section 9.18. Lender's Name
Lender's Address
Signature Date 11/06/2018
ARCHITECT'S DECLARATION