15040183CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10377 LAS ONDAS WAY
CONTRACTOR: SIERRA STRUCTURE INC
PERMIT NO: 15040183
OWNER'S NAME:
MEADOW VISTA, CA 95722
PHONE NO: (916) 275-1971
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
495 S.F. ADDITION TO ENLARGE KITCHEN, LIVING RM &
License Class Lic. # -721 Y 6 3
BEDROOM & ADD (N) BATH
Contractor ei rA-S-FP'UCfU✓ — Date Z
REV # 1 -UPGRADE (E) 100 AMP PANEL TO 200 AMP PANEL, SAME
I hereby affirm that I am licensed under the provisio s of Chapter 9
LOCATION - ISSUED 6/23/15
(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:
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
tormance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $200000
ha,e and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36929038.00
Occupancy Type:
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
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
180 DAYS FROM LAST CALLED INSPECTION.
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 ac c aga st said City in consequence of the
Issued by: Date:
granting of this permit. Additi al applicant understands and will comply
with all non -point source r ion er he Cupertino Municipal Code, Section
918.
/
RE -ROOFS:
Signature Date 23 v j
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I to remove all new materials for
installed without first obtaining an inspection, agree
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
1, 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)
HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
California
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 I use equipment or devices which emit hazardous
by the Bay Area A' rty I Ianagement District I
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined
will maintain compliance with the Cape icipal ode, Chapter 9.12 and
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2 3, and 534.
a _
6 ��
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: ��
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
C NSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10377 LAS ONDAS WAY
CONTRACTOR: SIERRA STRUCTURE INC PERMIT NO: 15040183
OWNER'S NAME:
MEADOW VISTA, CA 95722 PHONE NO: (916) 275-1971
11 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class—z— Lie. # —7'7 �9 G Z
495 S.F. ADDITION TO ENLARGE KITCHEN, LIVING RM &
Contractor �/ � -1/ 4 ��/ , G L s cL _ j s -
BEDROOM &ADD (N) BATH
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.
I hereby affirm under penalty of perjury one of the following two declarations:
I have an 1 maintain a certificate of consent to self -insure for Worker's
Censauo , as provided for by Section 3700 of the Labor Code, for the
;lop
a of the work for which this permit is issued.
-4A
- a and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area: Valuation: $200000
ection 3700 of the Labor Code, for the performance of the work for which this
is
permit i
APN Number: 36929038.00 Occupancy Type:
APPLICANT CERTIFICATION
I that I ha v read this application and state that the above information is
co ect. I agre o comply with all city and county ordinances laws
PERMIT EXPIRES IF WORK IS NOT STARTED
and state relating
t buildin onstruction, and hereby authorize representatives of this city to enter
WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
e above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino
180 DAYS FROM LAST CALLED INSPECTION.
against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the appl' derstands and will comply
with all non -point source
Issued by: Date:
re t' Cupe o Municipal Code, Section
9.18.
Signature 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, I agree to remove all new materials for
OWNER -BUILDER DECLARATION
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
declarations:
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I use equipment or devices w ' e it hazardous
performance of the work for which this permit is issued.
air contaminants as defined b the Ba Area Air
Y Y Qual' ana ent District I
will maintain compliance with the Cupertino Mu 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
,Chapter
the Health & Safety Code, Sections 25505, 25 3
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date: T�
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
CONRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such
I hereby affirm that there is a construction lending agency for the performance of
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
I certify that I have read this application and state that the above information is
Lender's Address
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
ARCHITECT'S DECLARATION
against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
Licensed Professional
Signature Date