10050099 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1215 STAFFORD DR CONTRACTOR:DE MATTEI CONST PERMIT NO: 10050099
OWNER'S NAME:
SAN JOSE,CA 95126 PHONE NO:(408)295-7516
❑ LICENSED CONTRACTOR'S DECLARATION
�� ��� BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
LicenseClass - _Lic.#
MECH r RESIDENTIAL r COMMERCIAL r
Contmctor4J_--M41rC-1 j Date 7-22 — to
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD SQFT TO(E)FAMRM,LIVING&MASTER SUITE;ADD
(commencing with Section 7000)of Division 3 of the Business&Professions SQFT®(E)ENTRY&GUEST BEDROOM,ADD GUEST BATH,NEW
Code and that my license is in full force and effect. PATIO&REMODEL KITCHEN,MASTER SUITE,LIVING
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.
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: Valuation:5400000
permit is issued.
APPLICANT CERTIFICATION APN Number:36211032.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OSPERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 D YS FROMT CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by L" , Date:
Signatu Date -22-/a
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,1 shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws ofCalifomia. If,after making this certificate ofexemption,
become subject to the Worker's Compensation provisions of the Labor Code,1
LENDING AGENCY
certify that I have read this application and state that the above information is I herebyaffirm that there is a construction lending agency for the performance of work's
correct.1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signatu '22;^ Licensed Professional
RMSION 11
CITY OF CUPERTINO BUILDING PERMIT DATE
BUILDING ADDRESS: 1215 STAFFORD DR CONTRACTOR:DE MATTEI CONST PERMIT NO: 10050099
OWNER'S NAME:
SAN JOSE,CA 95126 PHONE NO:(408)295-7516
❑ LICENSED CONTRACTOR'S DECLARATION
r r
�� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH r RESIDENTIAL r COMMERCIAL r
Contractor /l I / <fCyy JS 1 Date ��-2� r' 0
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD SQFT TO(E)FAMRM,LIVING&MASTER SUITE;ADD
(commencing with Section 7000)of Division 3 of the Business&Professions SQFT@(E)ENTRY&GUEST BEDROOM,ADD GUEST BATH,NEW
Code and that my license is in full force and effect. PATIO&REMODEL KITCHEN,MASTER SUITE,LIVING
I _ t o-1 y_t0 �� Pl b r+� (� d
1 hereby affirm under penalty of perjury one of the following two declarations: 15AXU4 '-p Q�
I have and will maintain a certificate of consent to self-insure for Worker's /�," �j t Ro-��f. M 1 f v p —1Y v 15t>�S t •�
Compensation,as provided for by Section 3700 of the Labor Code,for the I _ �S �, �.M� r T _
performance of the work for which this permit is issued. 4)t r Jam tel— t V J:c7 f r M 1 � �� r
have and will maintain Worker's Compensation Insurance,as provided for byJ '�''� J rte'�'
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:5400000
permit is issued.
APPLICANT CERTIFICATION APN Number:36211032.00 Occupancy Type:
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 2
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations the Cupertino Municipal Code,Section
9.18.
Signature Date Issued by: Date:
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino.Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
1 certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,
become subject to the Worker's Compensation provisions of the Labor Code,I must O
lending agency for the performance of work's
correct.1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
REVISION#
v�
CITY OF CUPERTINO BUILDING PERMIT DATE 1
BUILDING ADDRESS: 1215 STAFFORD DR CONTRACTOR:DE MATTEI CONST PERMIT NO: 10050099
OWNER'S NAME:
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class 13 Lic.N T7 0 �s !J✓ ADD SQFT TO(E)FAMRM,LIVING&MASTER SUITE;ADD
I /n�, SQFT@(E)ENTRY& GUEST BEDROOM,ADD GUEST
Contracto,1>,- ''4T7Cl C�5i. Date X31— BATH,NEW
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 PATIO&REMODEL KITCHEN, MASTER SUITE,LIVING
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect. 1/24/11-REV42-REVISE SHEAR WALLS,ROOF BEAM&
1 hereby affirm under penalty of perjury one of the following two declarations: FOUNDATION,ANCHORS,DELETE WINDOW&SKYLIGHTS-
1 have and will maintain a certificate of consent to self-insure for Worker's 1SSD 1/31/11
Compensation,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 Area: Valuation:$400000
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 APN Number:36211032.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Date —/ ��—!� 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.
❑ OWN UILDER DECLARATION
IV Signature of Applicant: Dale:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business'&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,
Dater
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,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date