B-2016-1920CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10279 JUDYAVE CUPERTINO, CA 95014-3524 (375 08 044)
OWNER'S NAME:
LICENSED COMACTOR'S DECLARATION
License Class 5 Lic. #948433
Contractor MADERO'S CONSTRUCTION Date 09/30/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
..j ,performance of the work for which this permit is issued.
z I have and will maintain Worker's Compensation Insurance, as provided for by
f 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 Cupertii A-agTins Iia i i ie gments, costs, and expenses which
may acc a gainst said City in conseqbiance of the granting of this permit.
Additiona ly, the applicant understands arlo will comply with all non -point
source regLLiations per the Cupertino ni ipal Code, Section 9.18.
Date 9/8/2016
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;
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.
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.
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CONTRACTOR: PERMIT NO: B-2016-1920
MADERO'S
CONSTRUCTION
MENLO PARK, CA
ISSUED: 09/08/2016
PHONE NO: (650) 679-4491
BUILDING PERMITINFO:
X_ BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
CONSTRUCT (N) GARAGE (396 S.F.); (I) REAR AND SIDE
ADDITION (755 S.F.); (1) COVERED PORCH (109 S.F.); OTHER
REMODEL AREA (890 S.F.); (I) 200 AMP PANEL; RE -ROOF (30 SQ'S)
Sq. Ft Floor Area: 1260 1 Valuation: $250000.00
i Number: Occupancy Type:
O8 044 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 CALLED INSPECTION.
Issued by: Abby Ayende
All roofs shall be inspected prior t any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
Signature of Applicant:
Date: 9/8/2016
TO
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 CuBer4hro'ill5mcipsLCode, Chapter 9.12 and the
Health & Safety Code, Sec 'fin 25532(a) should I stlo e or handle hazardous
material. Additionally, sh d I use equipment or device which emit hazardous
air contaminants as def d by the Bay Area Air Quality anagement District I
will maintain compliance '
Owner or authorized agent:
Date: 9/8/2016
CONSIRECTION' :NDYNG AGENCY
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
ARC'HITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed