15100117CITY OF CUPERTINO BUILDING PERMIT
BUMI)INGADDRESS: CONTRACTOR: PERMIT NO: 15100117
18763 BARNHART AVE CUPERTINO CA 95014 (375 17 058) ALPINE BUILDER
CONSTRUCTION
COMPANY INC
SAN JOSE, CA 95120
OWNER'S NAME. DEXTERDUNCAN I I DATE ISSUED: 05(0312016 (
OWNER'S PHONE: ( 1 1 PHONIC NO: (408) 268-6204
c r iN'R rig 11 _V,01
Class fi Lie. #838642
Date 09/30!2017
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
pith Section ?000) of Divislou 3 of the Business & Professions Code and that my
cense is in full force and effect,
hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
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
1 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 -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature . Date 10/2712016
BUILDING PERMIT INFO:
BLDG ELECT —PLUMB
MECH _ RESIDENTIAL_. COMMERCIAL
JOB DESCRIPTION:
DEMOLISH DETACHED GARAGE (330 SQ FT); CONSTRUCT ONE.
STOR.YADDITION (764 SQ FT); FRONT COVERED PORCH (35 SQ
FT); ATTACHED GARAGE (392 SQ FT); REMODEL KITCHEN (165 SQ
FT); BATHROOM REMODEL (75 SQ FT).
REV #1 RELOCATING FURNACE; REPLACING (N) FAMILY ROOM
BEAM; RELOCATE SINK & STOVEIOVEN; RELOCATE WINDOW
-KITCHEN. ISSUED 10/27/2016
Sq. Ft Floor Area; I Valuation: $250000.00
APN Number: Occupancy Typc:
375 17 058
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1.80 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
OWNER -BUILDER DECLARATION
I hereby affirm that am exempt from the Contractor's License Law for one of the 1Issued1by:KlMDUNBAR
wing two reasons:
i. 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 (Seo.7044, Business & Professions Code)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to consttuct the project (See.7044, Business & Professions Code).
RE. -ROOFS•
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed witho st obtaining an inspection, I agree to remove all new materials for
1 hereby affirm under penalty of perjury one of the following three declarations:
L I have and will maintain a Certificate of Consent to self -insure for Worker's Signature of
Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 10
performance of the work for which this permit is issued.
Z I have and will maintain Worker's Compensation Insurance, as provided for by Al
Section 3700 of the tabor Code, for the performanoe of the work for which this
permit is issued.
a. 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 subj act to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's ComponsatioTprovisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CFJUMCATM
I certify that 1 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 1112712016
HATARr 002 MAT5141ALS 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 DistrictI
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: 1 QL2712016
CONSTRUCTION LENDING AGENCS'
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
ARcHITEcTILs
I understand my plans shall be used as public records.
C,
CITY OF CUPERTINO BUILDING PERMIT f
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15100117
18763 BARNHART AVE CUPERTINO CA 95014 (375 17 058)
ALPINE BUILDER
CONSTRUCTION
COMPANY INC
f
SAN JOSE, CA 95120
OWNER'S NAME: DEXTER DUNCAN
DATE I5SIlED:-OS/03/2016
OWNER'S PHONE: (
PHONE NO: (;408) 268-6200
i
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. #838642
Contractor ALPINE BUILDER CONSTRUCTION COMPANY IN -C Date 09/30/2017
— BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH RESIDENTIAL
— — — C OMMERCLAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in faR force and effect.
JOB DESCRIPTION:
DEMOLISH DETACHED GARAGE (330 SQ FT); "CONSTRUCT ONE
I hereby affirm under penalty of perjury one of the following two declarations: '
STORY ADDITION (764 SQ FT); FRONT COVERED PORCH (35 SQ
i. I have and will maintain a certificate of consent to self -insure for Worker's
FT); ATTACHED GARAGE (392 SQ FT); REMODEL KITCHEN (165 SQ
Compensation, as provided for by Section 3700 of the Labor Code, for the
FT)' BATHROOM REMODEL (75 {SQ FT).
performance of the work for which this permit is issued.
I have and will-�maintain Worker's Compensation Insurance, as provided for by
REV #1 RELOCATING FURNACE; REPLACING (N) FAMILY ROOM
Section 3700 of the Labor Code, for the performance of the work for which this
BEAM; RELOCATE SINK & STOVE/OVEN; RELOCATE WINDOW
permit is issued.
-KITCHEN. ISSUED 10/27/2016
APPLICANT CERTITICATION
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: $50000.00
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
APN Number:
Occupancy Type:
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
375 17 058
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
' Date 10/27/2016
WITHIN 180 DAYS OF, PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
OWNEWBUILDERDECL RATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Issued by: KIM DUNBAR
following two reasons:
Z,
Dated U f`
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
sale (S&.7044, Business & Professions Code)
RE -ROOFS:
2. I, as owner of the property, am exclusively contracting with licensed
All roofs'shall be inspected prior to anyf roofing material being installed. If a roof is
contractors to construct the project (Sec.7044, Business &Professions Code).
installed witho st obtaining an inspection, I agree to remove all new materials for
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 -insure for Worker's t
pection.
)
-Signature ofApp'licant:
Compensation, as provided for by Section 3700 of the Labor Code, for the
Date: 10/27/2016 G"
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for b
P P y
ALL OF COVERNGSTO BE CLASS "A" OR BETTER
Section 3700 of the Labor Code, for the performance of the work for which this
-
permit is issued.
3. 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
Worker's Compensation laws of California. If, after making this certificate of
California Health &Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
exemption, I become subject to the Worker's Compensation provision of the
Healthi;& Safety Code, Section 2553�(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
I certifythat I have read this application and state that the above information is
PP
Ithe Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or authorized agent:
to enter upon the above mentioned property for inspection purposes. (We) agree
Date: 10/27/2016
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
CONSTRUCTION LENDING AGENCY
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 9.18.
Lender's Address
Signature Date 10/27/2016
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100117
18763 BARNHART AVE CUPERTINO CA 95014 (375 17 058) ALPINE BUILDER_
CONSTRUCTION
COMPANY INC
SAN JOSE, CA 95120
OWNER'S NAME: DEXTER DUNCAN DATE ISSUED: 05/03/2016
OWNER'S PHONE: PHONE NO: (408) 268-6200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMITINFO:
License Class B Lic. #838642
Contractor ALPINE BUILDER CONSTRUCTION COMPANY INC Date 09/30/2017
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. 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.
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.
Date/35 /2016
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of the
ving two reasons:
r. 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)
2. 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:
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.
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.
3. 1 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 revolted.
APPLICANT CERTIFICATION C
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.
Date/ /5 3 2016
BLDG —ELECT —PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
DEMOLISH DETACHED GARAGE (330 SQ FT); CONSTRUCT ONE
STORY ADDITION (764 SQ FT); FRONT COVERED PORCH (35 SQ
FT); ATTACHED GARAGE (392 SQ FT) REMODEL EXISTING
RESIDENCE (1048 SQ FT).
Sq. Ft Floor Area: I Valuation: $250000.00
APN Number: Occupancy Type:
375 17 058
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayendej
Date: 05/03/2016
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 ofAl
Date: 5/3/2016
BE CLASS "A" OR
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 255550/5, 225555333, and 25534.
O er or authorized agent: //
Date: 5/3/2016
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