B-2016-1839CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
11186 LINDA VISTA DR CUPERTINO, CA 95014-4770 (356 16 012)
CONTRACTOR:
C Y B
PERMIT NO: B-2016-1839
CONSTRUCTION INC
FREMONT, CA 94536
OWNER'S NAME: DEXTER CHARLES N AND LONNA L TRUSTEE
DATE ISSUED: 06/20/2016
OWNER'S PHONE: 646-520-9852
PHONE NO: (510) 857-3882
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRA TOR Lic. #945656
Contractor C Y B CONSTRUCTION INC Date 04/30/2018
X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH X 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:
I hereby affirm under penalty of perjury one of the following two declarations:
REMODEL/RECONFIGURE (E) AREA TO CREATE (I) MASTER
//i�
r. v 1 have and will maintain a certificate of consent to self -insure for Worker's
BEDROOM/BATH (332 S.F.); REMODEL 3 (E) BATHS (295 S.F.);
Compensation, as provided for by Section 3700 of the Labor Code, for the
RELOCATE FURNACE TO ATTIC; REPLACE 9 WINDOWS (ALL
performance of the work for which this permit is issued.
WOWS WILL MEET EGRESS & BE TEMPERED WHERE
REQUIRED BY CODE);
I have and will maintain Worker's Compensation Insurance, as provided for by
li
REPLACE SEWER LINE
Section 3700 of the Labor Code, for the performance of the work for which this
REV #1 - ADD RECESSED CEILING LIGHTS AND ELECTRICAL
permit is issued.
OUTLETS - LIVING ROOM, HALLWAYS & BEDROOMS; REPLACE
APPLICANT CERIUI ATION
ALL ELECTRICAL
I certify that I have read this application and state that the above
WIRES - ISSUED 7/13/16
information is correct. I agree to comply with all city and, county ordinances
and state laws relating to building construction, and hereby authorize
REV #2 - UPGRADE ELECT PANEL TO 200 AMPS - ISSUED 7/25/16
representatives of this city to enter upon the above mentioned property for
Sq. Ft Floor Area:
Valuation: $80000.00
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.
APN Number:
Occupancy Type:
Additionally, the applicant understands and will comply with all non -point
source regulations per the - upertino Municipal Code, Section 9.18.
356 16 012
Signature) Date
07/25/2016
PERMIT EXPIRES IF WORK IS NOT STARTED
OWNER -BUILDER DECLARATION
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
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
Issued by: MELISSA N
compensation, will do the work, and the structure is not intended or offered for
Dater 06/20/2016
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm under penalty of perjury one of the following three declarations:,
installed without first obtaining an inspection, I agree to remove all new materials for
r. I have and will maintain a Certificate of Consent to self -insure for Worker's
inspection.
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Signature ofApplicant:
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Date: 07/25/2016
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 ofCalifornia. If, after making this certificate of
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
exemption, I become subject to the Worker's Compensation provisions of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
Labor Code, I must forthwith comply with such provisions or this permit shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
be deemed revoked.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
APPLICANT CERTIFICATION
material. Additionally, should I use equipment or devices which emit hazardous
I certify that I have read this application and state that the above information is
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
correct. I agree to comply with all city and county ordinances and state Jaws
relating to building construction, and hereby authorize representatives of this city
the Health & Safety Code; Sections 255 , 25533, and 25534.
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Owner or authorized agent:
judgments, costs, and expenses which may accrue against said City in
Date: 07/25/2016
consequence of the granting of this permit. Additionally, the applicant understands
CONSTRUCTION LENDING AGENCY
and will comply with all non -point source regulations per the Cupertino Municipal
I hereby affirm that there is a construction lending agency for the performance
Code, Section 9.18.
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Signature Date 07/25/2016
Lender's Address
ARCHITECi'S DECLARATION
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300.TORRE AVENvF- • CUPERTINO, CA 950143255
(408) 777-3228 • FAX (408) 777-3333 • buildingPeupertino.org mist;
MDT T17 SSA RT] TT:iI± F-1..- -
MISCELLANEOUS V
PROJECT ADDRESS y r )-11V/
n Ill'!l {o "1 pr _ y 'Pt
APN # j / � ' 6) 2.•
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ER.
OWNNAME c
PHONE% Q b 21 �CJ�
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EMAIL
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STREET ADDRESS [ Q- � � i�
CITY, STATE, ZIP c . , ` n + t no FAX
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CONTACT NAME }� +
PHONE �j
E-MAIL j� r
STREET ADDRESS
CITY, STATE, ZIP
y� AWNER ❑ OWNER-)3—DER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACfORAGENT 11 ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT
CONTRACTORNAME
LICENSE NUMBER
LICENSETYPE
BUS. LIC#
COMPANYNAME
E-MAIL..
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECTJENGINEER NAME
LICENSE NUMBER
EUS. LIC fl
COMPANY NAME
-
E-MAIL_
r•AX
_
STREET ADDRESS
CITY, STATE, ZIP -_
-
PHONE
USE ONFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN VlILDLAND/
URBAN INTERFACE AREA, 11 yes @/N.
YROJECI 1N
rLoop zoNE D Yes V/No
DESCRIPTION OR WORK
ra ,d
TOTAL VALUATION,
1
_
RECEIVED BY � .
By my signature below, I certify to each of the following: I am the property ownerorautha ized agent to act on the property owner's behalf, I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws 1•eiating to buildin n�stll-uc�tiorL I authorize representatives of Cupelthio to enter the above-ideentified property for inspection purposes.
Signature of ApplicaaV.Agent:.-J'' Date: ( Z LL—
SUPPLEMENTAL INFORMATION REQUIRED
-/ C�/�''y .� - / / �( //�)
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R4EPM1sc.4p_2011.doc revised 03/1 d/11
C IUY
A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PE NO: B-2016-1839
11186 LINDA VISTA DR CUPERTINO, CA 95014-4770 (356 16 012)
C Y B
CONSTRUCTION INC
FREMONT, CA 94536
OWNER'S NAME: DEXTER CHARLES N AND LONNA L TRUSTEE
DATE I 3SUED: 07/13/2016 -
OWNER'S PHONE: 917-5964582
PHONE 0: (510) 857-3882
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #945656
Contractor Y B CONSTRUCTION INC Date 04/30/2018
X X BLDG ELECT X_ PL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH X 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:
REMODEL/RECONFIGURE ( ) AREA TO CREATE (N) MASTER
I hereby affirm under penalty of perjury one of the following two declarations:
BEDROOM/BATH (332 S.F.); I EMODEL 3 (E) BATHS (295 S.F.);
is _- I have and will maintain a certificate of consent to self -insure for Worker's
RELOCATE FURNACE TO AT FIC; REPLACE 9 WINDOWS (ALL
Compensation, as provided for by Section 3700 of the Labor Code, for the
WINDOWS WILL MEET EG SS & BE TEMPERED WHERE
performance of the work for which this permit is issued.
REQUIRED BY CODE); REPL kCE SEWER LINE
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-
REV #1 - ADD RECESSED CE LING LIGHTS AND ELECTRICAL
permit is issued.
OUTLETS - LIVING ROOM, F ALLWAYS & BEDROOMS; REPLACE
APPLICANT CERTIFICATION
ALL ELECTRICAL WIRES - ISUED 7/13/16
1 certify that I have read this application and state that the above
Sq. Ft Floor Area:
Valuatio : $80000.00
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
Number:
Occup -Icy Type:
inspection purposes. (We) agree to save indemnify and keep harmless the
356
356 16 012
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.
PERMIT EXPIRES F WORK IS NOT STARTED
WITHIN 180 DAYS F PERMIT ISSUANCE OR
Signature'-'" �..- ^� � �- Date 07/13/2016
180 DAYS FROM L ST CALLED INSPECTION.
OWNER -BUILDER DECLARATION
Issued by: MELIS 41E 5
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Date: 07/13/2016 -
I
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
1E -ROOFS:
compensation, will do the work, and the structure is not intended or offered for
All roofs shall be inspected prior t any roofing material being installed. If a roof is
sale (Sec.7044, Business & Professions Code)
installed without first obtaining ani Lspection, I agree to remove all new materials for
2. 1, as owner of the property, am exclusively contracting with licensed
inspection.
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
Signature of Applicant:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Date: 07/13/2016
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS I 4ATERIALSDISCLOSURE
permit is issued.
I have read the hazardous mate 'als requirements under Chapter 6.95 of the
a, 1 certify that in the performance of the work for which this permit is issued, I
California Health & Safety Co le, Sections 25505, 25533, and 25534. 1 will
shall not employ any person in any manner so as to become subject to the
maintain compliance with the Cu ertino Municipal Code, Chapter 9.12 and the
Worker's Compensation laws of California. If, after making this certificate of
Health & Safety Code, Section 5532(a) should I store or handle hazardous
exemption, I become subject to the Worker's Compensation provisions of the
material. Additionally, should I u ie equipment or devices which emit hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall
air contaminants as defined by th Bay Area Air Quality Management District I
be deemed revoked.
will maintain compliance with th Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Co le, Sections 25505, 25533, and 25534.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
Owner or authorized agent
correct. I agree to comply with all city and county ordinances and state laws
Date: 07/13/2016
relating to building construction, and hereby authorize representatives of this city
CONSTRUCAI N LENDIN A EN Y
to enter upon the above mentioned property for inspection purposes. (We) agree
I hereby affirm that there is a cor struction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities,
of work's for which this permit is ssued (Sec. 3097, Civ C.)
judgments, costs, and expenses which may accrue against said City in
Lender's Name
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Lender's Address
Code, Section 9.18.
ARCHITEC I IS DECLARATION
1 understand my plans shall be u ed as public records.
Signature Date 07/13/2016
Licensed
J4 1
PERMIT APPLICATION
L rMT
COMMUNITY DEVELOPMEi~iCONSTRUCTION
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m
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1839
11186 LINDA VISTA DR CUPERTINO, CA 95014-4770 (356 16 012)
C Y B
CONSTRUCTION INC
FREMONT, CA 94536
OWNER'S NAME: DEXTER CHARLES N AND LONNA L TRUSTEE
DATE ISSUED: 06/20/2016
OWNER'S PHONE: 646-520-9852
PHONE NO: (510) 857-3882
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class. B Lic. #94� 5566
Contractor C Y B CONSTRUCTION INC Date 04/30/2018
X BLDG —ELECT X PLUMB
X MECH X 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:
REMODEL/RECONFIGURE (E) AREA TO CREATE (N) MASTER
I hereby affirm under penalty of perjury one of the following two declarations:
BEDROOM/BATH (332 S.F.); REMODEL 3 (E) BATHS (295._S.F.);
1. I have and will maintain a certificate of consent to self -insure for Worker's
RELOCATE FURNACE TO ATTIC; REPLACE 9 WINDOWS (ALL
Compensation, as provided for by Section 3700 of the Labor Code, for the
WINDOWS WILL MEET EGRESS & BE TEMPERED WHERE
performance of the work for which this permit is issued.
REQUIRED BY CODE); REPLACE SEWER LINE
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: $80000.00
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
356 16 012
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.
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 ivy Date 6/301/2016
Issued by: Abby Ayende
Date: 06/20/2016 l�wvvleN�y"�
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 6/301/2016
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
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
exemption, I become subject to the Worker's Compensation provisions of the
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.L�—
Owner or authorized agent:
APPLICANT CERTIFICATION,
Date: 6/301/2016
1 certify that I have read this application and state that the abovE information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives 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. .
Licensed
Signature Date 6/301/2016
Professional