B-2016-1734CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1734
21891 LOMITAAVE CUPERTINO, CA 95014-2829 (357 16 075)
ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'S NAME:
DATE ISSUED: 08/15/2016
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #909433
ContractorALI'S CONSTRUCTION & REMODELING INC Date 01/31/2018
X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— M ECH X RESIDENTLA L — COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
CONSTRUCT (I) 2-STORY SFD (2,701.4 S.F.); (N) ATTACHEDGARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
(440 S.F.); (I) REAR PORCH (563 S.F.)
i. I have and will maintain a certificate of consent to self-insure for Worker's
REV#2 - REVISE KITCHEN PLAN & 2ND FLOOR BATHROOM -
Compensation, as provided for by Section 3700 of the Labor Code, for the
MOVING ONE WALL IN EACH ROOM - ISSUED 4/25/2017
` performance of the work for which this permit is issued.
REV # 1 - CHANGE PORCH STRUCTURE FROM WOOD TO
I have and will maintain Worker's Compensation Insurance, as provided for by
CONCRETE - ISSUED 9/20/16
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area: 3141
Valuation: $175000.00
APPLICANT CFRUEICATION
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 relating to building construction, and hereby authorize
APN Number:
Occupancy Type:
representatives of this city to enter upon the above mentioned property for
357 16 075
Deferred Submittal (R-3),R-3 (Custom),R-3 (Custom),U
inspection purposes. (We) agree to save indemnify and keep harmless the
(Private Gar /A U (Private Gar /A
g Bld g)' g Bld g)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
source regulations er the Cupertino Municipal Code, Section 9.18.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signatuvf Date 04/25/2017
'R UILDER ILM'O
Issued by: Abby Ayende
Date: 08/15/2016
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
RE-ROOFS:
compensation, will do the work and the structure is not intended or offered for
All roofs shall be inspected prior to any roofing material being installed. If a roof is
sale (Sec.7044, Business & Professions Code)
installed without first obtaining an inspection, I agree to remove all new materials for
z. I, as owner of the property, am exclusively contracting with licensed
inspection.
contractors to construct the project (Sec.7044, Business & Professions Code).
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations:
Date: 04/25/2017
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 ofthe Labor Code, for the performance of the work for which this
HAZARDOUS MATERIALS DISCLOSURE
permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
s. I certify that in the performance of the work for which this permit is issued, I
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Worker's Compensation laws of California. If, after making this certificate of
material. Additionally, should I use equipment or devices which emit hazardous
exemption, I become subject to the Worker's Compensation provisions of the
air contaminants as defined by the Bay Area Air Quality Management District I
Labor Code, I must forthwith comply with such provisions or this permit shall
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
be deemed revoked.
the Health & Safety Code, Seti s 25505, 25533, and 25534.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
Owner or authorized age��
correct. I agree to comply with all city and county ordinances and state laws
Date: 04/25/2017
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
I hereby affirm that there is a construction Wding agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities,
of work's for which this permit is issued (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
Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code, Section 9.18.
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Signature Date 04/25/2017
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR: PERMIT NO: B-2016-1734
21891 LOMITAAVE CUPERTINO, CA 95014-2829 (357 16 075) ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'SNAME: DATE ISSUED: 08/15/2016
OWNER'S PHONE: PHONE NO: (
License Class B Lia #909433
ContractorALI!$ CONSTRUCTION & REMODELING INC Date 01/31/2018
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.
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.
�
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 Municipal Code, Section 9.18.
Signature < / Date 09/20/2016
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)
2. I, 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.
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. 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.
Date 09/20/2016
BUILDING PERNHT INFO:
BLDG —ELECT _PLUMB
MECH X RESIDENTIAL — COMMERCIAL
JOB DESCRIPTION:
CONSTRUCT (N) 2 -STORY SFD (2,701.4 S.F.); (N)ATTACHED
GARAGE (440 S.F,); (I) REAR PORCH (563 S.F.)
REV # 1 - CHANGE PORCH STRUCTURE FROM WOOD TO
CONCRETE - ISSUED 9/20/16
Sq. Ft Floor Area: 3141 1Valuation: $175000.00
APN Number: Occupancy Type:
357 16 075 Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U
(Private Gar / Ag Bldg),U (Private Gar / Ag Bldg)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST INSPECTION.
Issued by:
Date: fttti 12 —
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Appl
Date: 09/20/2016
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: 09/20/2016 `.
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
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1734
21891 LOMITAAVE CUPERTINO, CA 95014-2829 (357 16 075)
ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'S NAME:
DATE ISSUED: 08/15/2016
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lia #909433
ContractorALI'S CONSTRUCTION & REMODELING INC Date 01/31/2018
X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ MECH X RESIDENTIAL s COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect:
JOB DESCRIPTION:
CONSTRUCT (1) 2 -STORY SFD (2,701.4 S.F.); (N) ATTACHED
I hereby affirm under penalty of perjury one of the following two declarations:
GARAGE (440 S.F.); (1) REAR PORCH (563 S.F.)
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
erformance of the work for which this permit is issued.
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.
Sq. Ft Floor Area: 3141
Valuation: $175000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
-
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
357 16 075
Deferred Submittal (11-3),R-3 (Custom),R-3 (Custom),U
representatives of this city to'enter upon the above mentioned property for
(Private Gar /Ag Bldg),U (Private Gar / Ag Bldg)
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.
PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally, the applican -understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations h C , ertino Municipal Cade, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Sig ature / Date 8/15/2016
Issued by: Abby Ayende
OWNER -BUILDER DECLARATION
Date: 08/15/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:.
RE -ROOFS:
1. I, as owner of the property, or my employees with wages as their sole
All roofs shall be inspected prior to any roofing material being installed. If a roof is
compensation, will do the work, and the structure is not intended or offered for
installed without first obtaining an inspection, I agree to remove all new materials for
sale(Sec.7044, Business & Professions Code),
inspection.
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
Signature ofApplicant:
Date: 8/15/2016
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
-
performance of the work for which this permit is issued.
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code, for the performance of the work for which this
, I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
s. I certify that in the performance of the work for which this permit is issued, I
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
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
exemption; I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cuper��n° Mu 'cipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, S e
-
APPLICANT CERTIFICATION
Owner or authorized agent:
I certify that I have read this application and state that the above information is 'bate:
8/15/2016
correct. I agree to comply with all city and county ordinances and state laws
CONSTRUCTION LENDING AGENC
relating to building construction, and hereby authorize representatives of this city
1 hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We) agree
of work's for which this permit is issued (Sec. 3097, Civ C.)
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Name
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
Lender's Address
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 8/15/2016
Licensed
Professional