BLD-2021-0459 PermitBUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 1 144 ROLLINGDELL CT Cupertino
APN: 359 34 012
PERMIT NO: BLD-2021-0459
OWNER'S NAME:
CONTRACTOR: QUYNH NGO, 1925 FERNISH DRIVE SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 7/9/2021 7:19:30 AM
ISSUED BY: KDUNBAR
VALUATION: $217000
JOB DESCRIPTION
THE REAR AND FRONT; KITCHEN REMODEL (220 SF); 1ST FLOOR BATHROOM/POWDER ROOM REMODEL (98 SF); OTHER REMODEL 1ST AND 2ND
DECK; ADD BAY WINDOW TO LIVING ROOM; ADD (7) SKYLIGHTS; NEW COVERED PORCH (79 SF); RE -ROOF (2348 SF) WITH NEW PLYWOOD;
SF STORAGE SHED; NEW 125 AMP SUBPANEL LOCATE IN STORAGE
1ST FLOOR ADDITION (436.75 SF) TO
FLOOR (1,241 SF); REMOVE 2ND FLOOR
UPGRADE PANEL TO 400 AMP; 120
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C10
LICENSED
EXP
02/28/2022
I hereby
force
I hereby
QUYNH NGO
CLASS:
ELECTRICAL, B GENERAL BUILDING
NO: 1011049
DATE:
affirm that I am licensed
and effect.
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California.
with such provisions or this
under the provisions of Chapter
one of the following three
of consent to self -insure
Compensation Insurance,
of the work for which this
If, after making this certificate
permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
V
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
representatives of this city to
liabilities, judgements, costs,
comply with all non -point source
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.