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10040061II CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19400 SORENSON AVE BLDG E I CONTRACTOR: LEON CONSTRUCTION PERMIT NO: 10040061 1 OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date 1 hereby affirm that 1 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. 18921 LOREE AVE CUPERTINO, CA 95014 DATE ISSUED: 08/10/20 10 PHONE NO: (408) 209-1272 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: SEISMIC UPGRADES, WINDOWS, GARAGE SHEAR WALLS;SEE PERMIT #10040059 FOR FEES 1 hereby affirm under penalty of perjury one of the following two declarations: 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. 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 Sq. Ft Floor Area: permit is issued. APPLICANT CERTIFICATION 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 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 to save indemnify and keep harness the 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. Signature, Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three declarations: 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. 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. I certify that in the performance of the work for which this permit is issued, 1 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 exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 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. Additionally, the applicant understands and will comply with �� Date Valuation: $200000 APN Number: 37503005.BLDGE I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D YS FROM AST CALLED INSPECTION. Issued by: O ' / 0 Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Date: l CONSTRUCTION LENDING AGENCY I 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 Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19400 SORENSON AVE BLDG E I CONTRACTOR: LEON CONSTRUCTION PERMIT NO: 10040061 1 OWNER'S NAME: 1 CUPERTINO, CA 95014 1 PHONE NO: (408) 209-1272 1 ❑ LICENSED CONTRACTOR'S DECLARATION License ClassLic. # To 0 PL 4- 2- Contractor � Date l� q I hereby affirm that 1 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. I hereby affirm under penalty of perjury one of the following two declarations: 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. 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 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. Additionally, the applicant understands and will comply with all non- Municipal Code, Section 9.18. Signature Date �a ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 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. I certify that in the performance of the work for which this permit is issued, I 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 exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH I— RESIDENTIAL I— COMMERCIAL JOB DESCRIPTION: SEISMIC UPGRADES, WINDOWS, GARAGE SHEAR WALLS;SEE PERMIT #10040059 FOR FEES 11/4/11- REVISION #1- REVISE GLASS WINDOW IN LIVING/DINING AREA, GLASS PICTURE WINDOW, SLIDING GLASS DOOR -ISSUED 12/19/) ) Sq. Ft Floor Area: Valuation: $200000 APN Number: 37503005.13LDGE Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. O LENDING AGENCY I 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 Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT ' BUILDING ADDRESS: 19400 SORENSON AVE BLDG E CONTRACTOR: LEON CONSTRUCTION PERMIT NO: 10040061 OWNER'S NAME: CUPERTINO, CA 9501[4 PHONE NO: (408) 209-1272 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r MECH RESIDENTIAL ` COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SEISMIC UPGRADES, WINDOWS, GARAGE SHEAR (commencing with Section 7000) of Division 3 of the Business & Professions WALLS;SEE PERMIT #10040059 FOR FEES Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1/24/2012 - REV#2 - REVISE MOMENT FRAME FOOTING AT FAMILY ROOM LOCATION(FEE ASSOC W/10040054)- REV#2 ISS'D 2/8/2012 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. I have and will maintain Worker's Compensation Insurance, a_e provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $200000 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 and state laws relating APN Number: 37503005.BLDGE Occupancy Type: to building construction, and hereby authorize 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 may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section WITHIN 180 DAYS OF PERMIT ISSUANCE OR 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: Date: OWNER -BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 1, as owner of the property, or my employees with wages as their sole compensation, All roofs shall be inspected prior to any roofing material being installed. If a roof is will do the work, and the structure is not intended or offered for sale (Sec.7044, installed without first obtaining an inspection, I agree to remove all new materials for Business & Professions Code) inspection. 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter4.91 of the Section 3700 of the Labor Code, for the performance of the work for which this and 2and4. I will maintain California Health &Safety Code, Sections 25de, compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Chapter permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material. I certify that in the performance of the work for which this permit is issued, I shall Additionally, should I use equipment or devices which emit hazardous air not employ any person in any manner so as to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation laws of California. If, after making this certificate of exemption, 1 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the become subject to the Worker's Compensation provisions of the Labor Code, I must Health & Safety Code, Sections 25505, 25533, and 25534. forthwith comply with such provisions or this permit shall be deemed revoked. : (�% APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. 1 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 I hereby affirm that there is a construction lending agency for the performance of Mrk's upon the above mentioned property for inspection purposes. (We) agree to save for which this permit is issued (Sec. 3097, Civ C.) indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Name costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Lender's Address with all non - Municipal Code, Section 9.18. ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professional