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14060191 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060191 10665 CORDOVA RD CUPERTINO CA 95014(342 22 10 1) JBS GREEN BUILDERS INC SARATOGA,CA 95070 OWNER'S NAME: DATE ISSUED:01/20/2016 OWNER'S PHONE: PHONE NO:(408)390-5577 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class b Lic.#980527 Contractor JBS GREEN BUILDERS INC Date 04/30/2019 —BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: **LOT A**HILLSIDE,CONSTRUCT 2 STORY SFDWL(2572 SQ FT); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE(466 SQ FT);COVERED PORCH(60 SQ FT); 1. I have and will maintain a certificate of consent to self-insure for Worker's SITE RETAINING WALL(S)ATTACHED&NEAR FOUNDATION Compensation,as provided for by Section 3700 of the Labor Code,for the REV#7-ADDING EPDXY SEGMENT TO CONNECT RETAINING performance of the work for which this permit is issued. WALL TO HOUSE CONCRETE STRUCTURE-ISSUED 4/23/19 I have and will maintain Worker's Compensation Insurance,as provided for by REV#6-REVISE SITE RETAINING WALL LAYOUT AND Section 3700 of the Labor Code,for the performance of the work for which this STRUCTURAL CALCULATIONS AND DETAILS.ISSUED 11/30/18 permit is issued. REV#5 -2ND FLOOR 1 (N)WINDOW UPSTAIRS BEDROOM APPLICANT CERTIFICATION -ISSUED 9-18-2017 1 certify that I have read this application and state that the above REV#4-2ND FLOOR 3 (N)WINDOWS UTILITY RM/MASTER information is correct. I agree to comply with all city and county ordinances BEDROOM-TO MEET EGRESS-ISSUED 8/3/2017 and state laws relating to building construction,and hereby authorize DEF# 1 -TRUSSES-ISSUED 4/23/19 representatives of this city to enter upon the above mentioned property for REV#1 -CHANGE PATIO LAYOUT TO MATCH GRADING PLAN inspection purposes. (We)agree to save indemnify and keep harmless the REVISIONS. ISSUED 6/7/16. City of Cupertino against liabilities,judgments, costs,and expenses which REV#2-ADD DECK-ISSUED 5/4/2017 may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point REV#3 -REVISE LAUNDRY ON MAIN FLOOR TO A WET BAR;ADD source regulations per the Cupertino Municipal Code, Section 9.18. UTILITY ROOM AND CLOSET TO SECOND FLOOR(116 SQ FT); ADD SKYLIGHT.-ISSUED 7/5/2017 Signature Date 4/23/19 Sq.Ft Floor Area: Valuation:$500000.00 OWNER-BUILDER DECLARATION APN Number: Occupancy Type: I hereby affirm that I am exempt from the Contractor's License Law for one of the 34222 101 following two reasons: 1. 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 PERMIT EXPIRES IF WORK IS NOT STARTED sale(Sec.7044,Business&Professions Code) WITHIN 180 DAYS OF PERMIT ISSUANCE OR 2. I,as owner of the property,am exclusively contracting with licensed 180 DAYS FROM LAST CALLED INSPECTION. contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: Issued by: Legacy 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date: 01/20/2016 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by RE-ROOFS: Section 3700 of the Labor Code,for the performance of the work for which this All roofs shall be inspected prior to any roofing material being installed.If a roof is g an installed without first obtaining inspection,I permit is issued. p � agree to remove all new materials for 3. I certify that in the performance of the work for which this permit is issued,I inspection. 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 Signature of Applicant: exemption,I become subject to the Worker's Compensation provisions of the Date:4/23/19 Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is HAZARDOUS MATERIALS DISCLOSURE correct. I agree to comply with all city and county ordinances and state laws I have read the hazardous materials requirements under Chapter 6.95 of the relating to building construction,and hereby authorize representatives of this city California Health&Safety Code,Sections 25505,25533,and 25534. I will to enter upon the above mentioned property for inspection purposes. (We)agree maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the to save indemnify and keep harmless the City of Cupertino against liabilities, Health&Safety Code,Section 25532(a)should I store or handle hazardous judgments, costs, and expenses which may accrue against said City in material. Additionally,should I use equipment or devices which emit hazardous consequence of the granting of this permit. Additionally,the applicant understands air contaminants as defined by the Bay Area Air Quality Management District I and will comply with all non-point source regulations per the Cupertino Municipal will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Code,Section 9.18. the Health&Safety Code,Sections 2 505,25533,and 25534. Signature Date 4/23/19 Owner or authorized agent: -� Date:4/23/19 CONSTRUCTION LENDING AGENCY CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060191 10665 CORDOVA RD CUPERTINO CA 95014 (342 22 101) J B S CONSTRUCTION SARATOGA, CA 95070 OWNER'S NAME: DATE ISSUED: 01/20/2016 OWNER'S PHONE: PHONE NO: (408) 390-5577 LICENSED CONTRACTOR'q DECLARATION BUILDING PERMIT INFO: License Class A. B. C-29 Lic. #980527 Contractor J B S CONSTRUCTION Date 01/31/2019 — BLDG —ELECT —PLUMB MECH 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: **LOT A** HILLSIDE, CONSTRUCT 2 STORY SFDWL (2572 SQ FT); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (466 SQ FT); COVERED PORCH (60 SQ FT); t. I have and will maintain a certificate of consent to self -insure for Worker's SITE RETAINING WALL(S) ATTACHED & NEAR FOUNDATION. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV # 1 - CHANGE PATIO LAYOUT TO MATCH GRADING PLAN have and will maintain Worker's Compensation Insurance, as provided for by REVISIONS. ISSUED 6/7/16. Section 3700 of the Labor Code, for the performance of the work for which this REV # 2 - ADD DECK - ISSUED 5/4/2017 permit is issued. REV #3 - REVISE LAUNDRY ON MAIN FLOOR TO A WET BAR; ADD APPLICANT CERTIFICATION UTILITY ROOM AND CLOSET TO SECOND FLOOR (116 SQ FT); I certify that I have read this application and state that the above ADD SKYLIGHT. —1,54Mej 1- �� q information is correct. I agree to comply with all city and county ordinances **BIN A5.5** w 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 Sq. Ft Floor Area: Valuation: $500000.00 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 APN Number: Occupancy Type: source regulations per the Cupertino Municipal Code, Section 9.18. / 34222 101 Signature Date 7/5/2012 PERMIT EXPIRES IF WORK IS NOT STARTED OWNER -BUILDER DECLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I hereby affirm that I am exempt from the Contractor's License Law for one of the 180 DAYS FROM LAST CALLED INSPECTION. following two reasons: 1. 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 Issued by: ABBY AYENDE sale (Sec.7044, Business & Professions Code) Date: 01/20/2016 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). RE -ROOFS: I hereby affirm under penalty of perjury one of the following three declarations: All roofs shall be inspected prior to any roofing material being installed. If a roof is r. I have and will maintain a Certificate of Consent to self -insure for Worker's installed without fust obtaining an inspection, I agree to remove all new materials for Compensation, as provided for by Section 3700 of the Labor Code, for the inspection. performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance, as provided for by Signature of Applicant: Section 3700 of the Labor Code, for the performance of the work for which this Date: 7/5/2017 permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Labor Code, I must forthwith comply with such provisions or this permit shall I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will be deemed revoked. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the APPLICANT CERTIFICATION Health & Safety Code, Section 25532(a) should I store or handle hazardous I certify that I have read this application and state that the above information is material. Additionally, should I use equipment or devices which emit hazardous correct. I agree to comply with all city and county ordinances and state laws air contaminants as defined by the Bay Area Air Quality Management District I relating to building construction, and hereby authorize representatives of this city wit] maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and to enter upon the above mentioned property for inspection purposes. (We) agree the Health & Safety Code, Sections 25 5, 25533, and 2 34. to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Owner or authorized agent: consequence of the granting of this permit. Additionally, the applicant understands Date: 7/5/2017 and will comply with all non -point source regulations per the Cupertino Municipal CONSTRUCTION LENDING AGENCY Code, Section 9.18. 1 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.) Signature Date 7/5/2017 Lender's Name Lender's Address CITY OF CUPERTINO BUILDING PERMIT BUH.DINGADDRESS: CONTRACTOR: PERMIT NO: 14060191 10665 CORDOVARD CUPERTINO CA 95014 (342 22 101) HOMEOWNER BUILDER SARATOGA, CA 95070 OWNER'S NAME: DATE ISSUED: 01/20/2016 OWNER'S PHONE: PHONE NO: (408) 390-5577 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class MASONRY Lic. #980527 Contractor HOMEOWNER BUILDER Date 01/31/2019 —BLDG —ELECT —PLUMB MECH 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: **LOT A** HILLSIDE, CONSTRUCT 2 STORY SFDWL (2572 1 hereby affirm under penalty of perjury one of the following two declarations: SQ FT); ATTACHED GARAGE (466 SQ FT); COVERED PORCH 1. I have and will maintain a certificate of consent to self-insure for Worker's (60 SQ FT); SITE RETAINING WALL(S) ATTACHED & NEAR Compensation, as provided for by Section 3700 of the Labor Code, for the FOUNDATION. performance of the work for which this permit is issued. REV # 1 - CHANGE PATIO LAYOUT TO MATCH GRADING PLAN 2. I have and will maintain Worker's Compensation Insurance, as provided for by REVISIONS. ISSUED 6/7/16. Section 3700 of the Labor Code, for the performance of the work for which this REV # 2 -ADD DECK - ISSUE_ D 5/4/2017 permit is issued. 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 Sq. Ft Floor Area: Valuation: $500000.00 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 APN Number: Occupancy Type: may accrue against said City in consequence of the granting of this permit. 342 22 101 Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18; PERMIT EXPIRES IF WORK IS NOT STARTED Signature Date 5/4/2017 WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: ABBY AYENDE following two reasons: Date: 01/20/2016 1. 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 ,sate (Sec.7044, Business & Professions Code) Las owner of the property, am exclusively contracting with licensed RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is contractors to construct the project (Sec.7044, Business & Professions Code). installed without first obtaining an inspection, I agree to remove all new materials for inspection. I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insurefor Worker's Signature of Applicant: Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 5/4/2017 erformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER / section 3700 of the Labor Code, for the performance of the work for which this permit is issued. s. 1 certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the exemption, I become subject to the Worker's Compensation provisions of the Health & Safety Code, Section 25532(a) should I store or handle hazardous Labor Code, I must forthwith comply with such provisions or this permit shall material. Additionally, should I use equipment or devices which emit hazardous be deemed revoked. 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 APPLICANT CERTIFICATION the Health & Safety Code, Sections 25505, 25533, and 25534. 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 2017 to save indemnify and keep harmless the City of Cupertino against liabilities, CONSTRUCTION LENDING AGENCY judgments, costs, and expenses which may accrue against said City in I hereby affirm that there is a construction lending agency for the performance consequence of the granting of this permit. Additionally, the applicant understands of work's for which this permit is issued (Sec. 3097, Civ C.) and will comply with all non-point source regulations per the Cupertino Municipal Lender's Name Code, Section 9.1 . Lender's Address _17j nature Date 5/4/2017 ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060191 10665 CORDOVA RD CUPERTINO CA 95014 (342 22 101) OWNER BUILDER OWNER'S NAME: OWNER'S PHONE: LICENSED CONTRACTOR'S D C"I ARATION License Class Lic. # Contractor OWNER BUILDER Date 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: 1. 1 have and will maintaina 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. 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. 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. Signature_ Date 6/7/16 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 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. } 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 DATE ISSUED: 01/20/2016 PHONE NO: INFO: —BLDG —ELECT —PLUMB — MECH _ RESIDENTIAL COMMERCIAL JOB DESCRIPTION: **LOT A** HILLSIDE, CONSTRUCT 2 STORY SFDWL (2572 SQ FT); ATTACHED GARAGE (466 SQ FT); COVERED PORCH (60 SQ FT); SITE RETAINING WALL(S) ATTACHED & NEAR Sq. Ft Floor Area: I Valuation: $500000.00 "N Number:" Occupancy Type: 342 22101 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: SEAN HATCH 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; Dater 6/7/i 6 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. Owner or authorized Date: 6/7/16 CONSTRUCTION LENDING AGENCY I hereby affirm that theres.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 understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: ORCTPERMIT NO: 14060191 CONTRA 10665 CORDOVA RD CUPERTINO CA 95014 (342 22 10 1) CONTRACTOR- t� , OWNER'S NAME: DATE ISSUED: OWNER'S PHONE: � PHONE NO: \ 1 1\ t• 1: 1 •'• 1� License Class Lic. # Contractor Date 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: t. 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. 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. 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. 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: 1. 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) 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: r. 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. z. 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. Signature_ Date 112— cl BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: **LOT A** HILLSIDE, CONSTRUCT 2 STORY SFDWL (2572 SQ FT); ATTACHED GARAGE (466 SQ FT); COVERED PORCH (60 SQ FT); SITE RETAINING WALL(S) ATTACHED & NEAR FOUNDATION. Sq. Ft Floor Area: I Valuation: $500000.00 APN Number: Occupancy Type: 34222 101 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 _ CALLED INSPECTION. Date: // 7i U //-a 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 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. Owner or authorized agent: Date: 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 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060191 10665 CORDOVA RD CUPERTINO CA 95014 (342 22 10 1) JBS GREEN BUILDERS INC SARATOGA, CA 95070 OWNER'S NAME: DATE ISSUED: 01/20/2016 OWNER'S PHONE: PHONE NO: (408) 390-5577 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a,b,c-29 Lic. #980527 Contractor JBS GREEN BUILDERS INC Date 04/30/2019 — BLDG — ELECT — PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH ^ RESIDENTIAL f COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: **LOT A** HILLSIDE, CONSTRUCT 2 STORY SFDWL (2572 SQ FT)'; I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (466 SQ FT); COVERED PORCH (60 SQ FT); 1. I have and will maintain a certificate of consent to self-insure for Worker's SITE RETAINING WALLS) ATTACHED & NEAR FOUNDATION Compensation, as provided for by Section 3700 of the Labor Code, for the REV #6 - REVISE SITE RETAINING WALL LAYOUT AND performance of the work for which this permit is issued. STRUCTURAL CALCULATIONS AND DETAILS, ISSUED 11/30/18 I have and will maintain Worker's Compensation Insurance, as provided for by REV # 5 - 2ND FLOOR 1 (N) WINDOW UPSTAIRS BEDROOM Section 3700 of the Labor Code, for the performance of the work for which this -ISSUED 9-18-2017 permit is issued. REV # 4 - 2ND FLOOR 3 (N) WINDOWS UTILITY RM/MASTER APPLICANT CERTIFICATION. BEDROOM - TO MEET EGRESS - ISSUED 8/3/2017 1 certify that I have read this application and state that the above DEF # 1 - TRUSSES information is correct. I agree to comply with all city and county ordinances REV # 1 - CHANGE PATIO LAYOUT TO MATCH GRADING PLAN and state laws relating to building construction, and hereby authorize REVISIONS. ISSUED 6/7/16. representatives of this city to enter upon the above mentioned property for REV # 2 - ADD DECK - ISSUED 5/4/2017 inspection purposes. (We) agree to save indemnify and keep harmless the REV #3 - REVISE LAUNDRY ON MAIN FLOOR TO A WET BAR; ADD City of Cupertino against liabilities, judgments, costs, and expenses which UTILITY ROOM AND CLOSETTO SECOND S ; may accrue against said City in consequence of the granting'of this permit. FLOOR (116 Q FT) Additionally, the applicant understands and will comply with all non-point ADD SKYLIGHT. - ISSUED 7/5/2017 source regulations per the Cupertino Municipal Code, Section 9.18. **B** Signature Date 11/30/18 Sq. Ft Floor Area: Valuation: $500000.00 OWNER-BUILDER DECLARATION APN Number: Occupancy Type: I hereby affirm that I am exempt from the Contractor's License Law for one of the 342 22 101 following two reasons: 1. 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 PERMIT EXPIRES IF WORK IS NOT STARTED sale (Sec.7044, Business & Professions Code) WITHIN 180 DAYS OF PERMIT ISSUANCE OR 2, I, as owner of the property, am exclusively contracting with licensed 180 DAYS FROM LAST CALLED INSPECTION, contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: Issued by: Legacy 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date: 01/20/2016 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by RE-ROOFS: Section 3700 of the Labor Code, for the performance of the work for which this All roofs shall be inspected prior to any roofing material being installed. If a roof is permit is issued. installed without first obtaining an inspection, I agree to remove all new materials for, 3. I certify that in the performance of the work for which this permit is issued, I inspection. 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 Signature of Applicant: exemption, I become subject to the Worker's Compensation provisions of the Date: 11/30/18 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is HAZARDOUS MATERIALS DISCLOSURE correct. I agree to comply with all city and county ordinances and state laws I have read the hazardous materials requirements under Chapter 6.95 of the relating to building construction, and hereby authorize representatives of this city California Health & Safety Code, Sections 25505, 25533, and 25534. I will to enter upon the above mentioned property for inspection purposes. (We) agree maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the to save indemnify and keep harmless the City of Cupertino against liabilities, Health.& Safety Code, Section 25532(a) should I store or handle hazardous judgments, costs, and expenses which may-accrue against said City in material. Additionally, should I use equipment or devices which emit hazardous consequence of the granting of this permit. Additionally, the applicant understands air contaminants as defined by the Bay Area Air Quality Management District I and will comply with all non-point source regulations per the Cupertino Municipal will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Code, Section 9.18. the Health.& Safety Code, Sections 25505, 25533, and 25534. SignatureDate 11/30/18 Owner or authorized agent: Date: 11/30/18 CONSTRUCTION LENDING AGENCY CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10665 cordova rd DATE: 06/30/2014 REVIEWED BY: Mendez PC FEE ID l APN: BP#: "VALUATION: 1$500,000 II-B'111-B,Iv,v-B *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: p 2nd Unit? Yes (!)No PENTAMATION 1 R3HIL PERMIT TYPE: WORK construct 2 story sfdwl 2986 s attached garage 480 and porch 68 s SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Hillside, Custom) II-B'111-B,Iv,v-B 3,534 $5,394.22 IR3HPLNCK $3,427.64 IR3HINSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,427.64 Suppl. Insp. Fee:O Reg. Q O"I 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 3,534 $5,394.22 $3,427.64 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, rare, sanitary Sewer utstrtct, ,3cnoot Ilictrici et- ) Thane feet are based nn the nreliminary information available and are on[v an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,394.22 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F)Reg. Q OT T 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,427.64 Suppl. Insp. Fee:O Reg. Q O"I 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 14new units $659.99 0 Work Without Permit? © Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $494.76 Select a Non -Residential Building or Structure O 0 i Strong Motion. Fee: IBSEISMICR $50.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $20.00 SUBTOTALS: P10,046.61 $0.00 TOTAL FEE: 1 $10,046.61 Revised: 04/01/2014