B-2016-1956CITY OF CUPERTINO BUILDING PERMIT ,
BUII.DINGADDRESS:
CONTRACTOR:
PERMIT NO: B-201'6-1956
7505 HEATHERWOOD DR CUPERTINO, CA 95014-5840 (359 26 051)
HOMEOWNER/BUILD
ER
OWNER'S NAME: LI ERIC H AND APRIL C
DATE ISSUED: 06%14/2016 r
is
OWNER'S PHONE:
PHONE NO:
6 tl
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. #
Contractor HOMEOWNER/BUILDER Date
X BLDG _ ELECT X PLUMB
MECH X RESIDENTIALCOMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— — — Is
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
MSTR BATH ADDITION (136 S.F.); REMODEL MSTR BEDROOM (280
I hereby affirm under penalty of perjury one of the following two declarations:
S.F.).
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
REV 1- ADD TANKLESS WATER HEATER - ISSUED 8/11/2016
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
Sq. Ft Floor Area:
Valuation: $125000.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
i�
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
359 26 051
R-3 (Custom)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
a.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8M.1/2016
Issued by: Abby-ygnde
Date: 06/14/2016 u
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection'
sale (Sec.7044, Business & Professions Code)
Signature
1i 57' 1, as owner of the property, am exclusively contracting with licensed
ofApplicant:
f , contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 8/11/2016
I hereby affirm under penalty of perjury one of the following three declarations:
�I
ALL ,ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIAL'S DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health &Safety Code, Sections 25505, 25533, and 25534. I will
'
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
a. I certify that in the performance ofthe work for which this permit is issued I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay ArealAir Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino=Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections' 25505,2 5533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. ,
Owner or authorized agent:
APPLICANT CERTIFICATION
.Date: /11/2 1
CONSTRUCTION I ENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C,)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
o
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
is
�- '-
Licensed
Signature _- %Date !11 1
Professional �
CITY OF C7UPERTINO
BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1956
7505 HEATHERWOOD DR CUPERTINO, CA 95014-5840 (359 26 051)
HOMEOWNER/BUILD
ER
OWNER'S NAME: LI ERIC H AND APRIL C
DATE ISSUED: 06/14/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. #
Contractor HOMEOWNER/ BUILDER Date
X BLDG —ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter (commencing
_
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
MSIR BATH ADDITION (136 S.F.); REMODEL MSIR BEDROOM (280
I hereby affirm under penalty of perjury one of the following two declarations:
S.F.).
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.
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
Sq. Ft Floor Area:
Valuation: $125000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
359 26 051
R-3 (Custom)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
comply non
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will with all -point
source regulations per the Cupertino Municipal Code, Section 9118.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date16/ 4/2016
Issued by: Abby Avende
Date: 06/14/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
i. I, as owner of the propertyor my employees with wages a their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not inti nded or offered for
inspection.
sale (Sec.7044, Business &Professions Code)
as owner of the property, am exclusively contracting witty licensed
Signature ofApplicant:
VV contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 6/14/2016
I hereby affirm under penalty of perjury one of the following three declarations:
I have and maintain a Certificate of Consent to self -insure for Worker's
ALL ROO# COVERINGS TO BE CLASS "A" OR BETTER
1. will
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit
/J V I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
�`� shall not employ any person in any manner so as to become subject to the
defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as
Code, Chapter 9.12
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
_
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6/14/2016
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
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize represen{atives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature / � ' Date 14 201
Licensed
9 �� �
Professional