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B-2017-0923 + REV#1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0923 10938 BARRANCA DR CUPERTINO,CA 95014-0102(326 02 003) OWNER/BUILDER OWNER'S NAME: PHONE NO: • LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: • License Class Lic.# Contractor OWNER/BUILDER Date 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: 1ST FLOOR ADDITION MASTER BEDROOM/MASTER BATHROOM- I hereby affirm under penalty of perjury one of the following two declarations: . (1133 SF); a. I have and will maintain a certificate of consent to self-insure for Worker's ATTACHED GARAGE ADDITION(441 SF);(2)PORCHES(124 SQ); Compensation,as provided for by Section 3700 of the Labor Code,for the REMODEL(1,416 S.F.);UPGRADE MAIN PANEL(200 AMP);FULLY performance of the work for which this permit is issued. SPRINKLER HOUSE 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. , q.Ft Floor Area: 1133 Valuation:$200000.00 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 326 02 003 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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10-20-2017 Issued by:Kim Dunbar . Date: 10/20/2017 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. 1,, 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: 10-20-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER a. 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 avehave 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 �r 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,l 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 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 s de,Sections 2 15,25533,and 25534. ' Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized APPLICANT CERTIFICATION Date:10-20-2017 I certify that I have read this application and state that the above information is CONSTR 'rTION 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, • CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0923 10938 BARRANCA DR CUPERTINO,CA 95014-0102(326 02 003) HAMILTON BUILDERS INC SAN JOSE,CA 95127 OWNER'S NAME: PHONE NO:(408)687-1109 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Up.#998293 Contractor HAMILTON BUILDERS INC Date 10/31/2018 X BLDG X ELECT_PLUMB 1 hereby affirm that 1 am licensed under the provisions at Chapterit(commencing —MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 ofthe Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: 1ST FLOOR ADDITION MASTER BEDROOM/MASTER BATHROOM- 1 hereby affirm under penalty of perjury one of the following two declarations: (1133 SF);ATTACHED GARAGE ADDITION(441 SF);(2)PORCHES r. 1 have and will maintain a certificate of consent to self-insure for Worker's (124 SQ);REMODEL(1,416 S.F.);UPGRADE MAIN PANEL(200 AMP); Compensation,as provided for by Section 3700 of the Labor Cade,for the FULLY SPRINKLER HOUSE. performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance,as provided for by REV#I-CONSTRUCT ROOF STRUCTURE,OV ER(E)ROOF Section 3700 ofthe Labor Cade,for the performance of the work for which this STRUCTURE TO TIE INTO(N)-TRUSSES-ISSUED 05-29-2018 permit is issued. APPLICANT CERTIFICATION — Sq.Ft Floor Area:1133 Valuation:$200000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 02 003 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 City In co 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. Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 05-29-2018 Issued by:Kim Dunbar // Date:10/20/2017 OWNEI2,BUH.DER DECLARATION I hereby affirm that I out exempt from the Contractor's License Lav for are of the RE-ROOFS, fallowing five reasons: All roofs shall be inspected prior to ally roofing material being installed.If a roof is r. 1,as owner of the property,or my employees with wagcs a,,their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the stricture is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature ofAppiicant: contractors to construct the pr ject(Sec.7044,Business&Professions Code), Date:05-29-2018 1 hereby affirm under penalty a]perjury one ofthe following three declarations: r. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO 13E CLASS"A"OR BETTER Compensation,as provided for by Section 3700 of the Labor Code,for the ,performance ofthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE x. 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 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. 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 shall not employ any person in any macnor so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous Worker's Compensation laws of Califonria, If,atter making this certificate it' air contaminants as dented by the Bay Area At,-Quality Management District I 1 ) Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 112 and exemption,1 become forthwith to the Worker's Com file Ilealtb&Safety and 25534. , Labor Code,I must Forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Data:06-29-2018 I certify that I have read this application and state that the above information is CONST UC" N LENDIN tG F.NCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that Cher_sem, nstruction 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. Data 05-29-2018 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2017-0923 10938 BARRANCA DR CUPERTINO,CA 95014-0102(326 02 003) HAMILTON BUILDERS INC SAN JOSE,CA 95127 OWNER'S NAME: DATE ISSUED:10/20/2017 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#998293 X BLDG X ELECT_PLUMB Contractor HAMILTON BUILDERS INC Date 10/31/2018 — 1 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 Cade and that my license is in fall farce and effect. JOB DESCRIPTION: 1 ST FLOOR ADDITION MASTER BEDROOM/MASTER BATHROOM- 1 hereby affirm under penalty of perjury one of the following two declarations: (]133 SF);ATTACHED GARAGE ADDITION(441 SF);(2)PORCHES r. I have and will maintain a certificate of consent to self-insure for Worker's (]24 SQ);REMODEL(1,416 S.F.);UPGRADE MAIN PANEL(200 AMP). / Compensation,as provided for by Section 3700 of the Labor Code,for the DEFERRED SUB#I: ROOF TRUSSES.ISSUED 06/07/2018 performance of the work for which this permit is issued. z. 1 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. Sq.Ft Floor Arent 1133 Valuation:$200000.00 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 326 02 003 R-3(Custom) representatives of Mils 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 u9 erslands and will comply with all non-point source regulations �e pertino Municipal Cade,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature —© Date Issued by:Kim Dunbar Date:10/20/2017 OWIYE -B ILDERDECLARATION I h466y y 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.To 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 stmcture is not intended or offered for inspection. 'ale(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 Cade). Date: 1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Seetiou 3700 of the Labor Code,for the performance Ofthe 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 read the hazardmis mafmdots requirements under Chapter 6.95 of the Section 3700 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the a. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(x)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 hivardous air contaminants as defined by the Bay Area Air Quality Management District 1 Worker's Compensation laws ofCalifornis,If,after making this certificate of will maintain,compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the WmIcc,'s Compensation provisions of the the Health&Safety Code,Sect or s 25 b5,25533,and 25534. Labor Code,l must forthwith comply with such previsions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CE'R'TIFICATION Date: I certify that I have read this application and state that the above information is CONSTR, T LE Df GEN Y correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there' ap nstruction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this unfit 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 Liceed Professional