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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