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B-2016-2796CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2796 21700 RAINBOW CT CUPERTINO, CA 95014-4829 (366 38 002) HAYES CONSTRUCTION REDWOOD ESTATES, CA 95044 OWNER'S NAME: PHONE NO: (408) 857-7827 LICENSED CONTRACTOR'S DECLARATION BUILDING PERM1T INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #946362 —ELECT X BLDG — Contractor HAYES CONSTRUCTION Date 04/30/2018 — T —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDNTLAL —COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: TERMITE DRY ROT REPAIR AN VOLUNTARY SEISMIC UPGRADE I hereby affirm under penalty of perjury one of the following two declarations: REV #1 - REVISE STRUCTURAL HOLD DOWN - ISSUED 12/21/2016 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 erformance of the work for which this permit is issued. ve 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: Valuation: $25000.00 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, t e applicant understands and will comply with all non -point source regula ions. per the Cupertino Municipal Code, Section 9.18. 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 (Seo.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. s. 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. C 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 12/21/2016 APN Number: I Occupancy Type: 366 38 002 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Abby Avende RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 12/21/2016 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 do 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 qupertino Municipal Code, Chapter 9.12 and the Health & Safety Cod¢¢, Sections 25505, 25533, and 25534. r or authorized 12/21/2016 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 i _i CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2796 21700 RAINBOW CT CUPERTINO, CA 95014-4829 (366 38 002) HAYES CONSTRUCTION REDWOOD ESTATES, CA 05044 OWNER'S NAME: I PHONE NO: (408) 857-7827' LICENSED CONTRACTOR I ' DECLARATION BUILDING PERMIT INFO: License Class la Lic. #946= Contractor HAYES CONSTRUCTION Date 04/30/2018 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ 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. JOT DESCRIPTION: TERMITE DRY ROT REPAIR AN VOLUNTARY SEISMIC UPGRADE 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 y� Compensation, as provided for by Section 3700 of the Labor Code, for the i—'__,performance of the work for which this permit is issued. 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. Sq. IF t Floor Area: Valuation:$25000.00 APPLICANT CERTIFICATION I 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 366 8 002 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 P RMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point THIN 180 DAYS OF PERMIT ISSUANCE OR source reguiltions per the Cupertino Municipal Code, Section 9.18. 1110 DAYS FROM LAST CALLED INSPECTION. 26/2016 Issued by: AbbyAyende OWNER-B lii D R 6ECLARATION Date: 09/26/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All oofs shall be inspected prior to any roofing material being installed. If a roof is . I, as owner of the property, or my employees with wages as their sole insta led 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 (See.7044, Business & Professions Code). Date: 9/26/2016 I hereby affirm under penalty of perjury one of the following three declarations: . 1 have and will maintain a Certificate of Consent to self insure for Worker's AT,i •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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I ve 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 permit is issued. ma taro 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 mat air contaminants riaL Additionally, should I use equipment or devices which emit hazardous as defined by the Bay Area Air 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 Labor Code, I must forthwith comply with such provisions or this permit shall / be deemed revoked. Own ar or authorized agent: APPLICANT CERTIFICATION -Date: 9/26/2016 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 her by affirm that there is a construction lending agency for the performance relating to building construction; and hereby authorize representatives of this city of w rk'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. Si Signature Date 9/26/2016 g Lice Prof sed ssional CITY OF BUILDING PERMIT is CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 PHONE 408-777-3228 CUPERTINO WWW•CUPERTINO.ORG BUILDING ADDRESS:21700 RAINBOW Ct, CUPERTINO, CA 9501 APN:366 38 002 PERMIT NO: B-2016-2796 OWNER'S NAME: OWNER'S PHONE: CONTRACTOR: CONTRACTOR PHONE: DATE ISSUED: 9/29/2020 1 ISSUED BY: Phuong D VALUATION: $25,000 JOB DESCRIPTION: TERMITE DRY ROT REPAIR AN VOLUNTARY SEISMIC UPGRADE REV #1 - REVISE STRUCTURAL HOLD DOWN - ISSUED 12/21 /2016 OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ❑ I, as owner of the property, or my employees with wages as their role compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professions Code). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & L Profession Code). I hereby affirm under penalty of perjury one of the following three declarations: ❑ 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. ❑ 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. 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,1 must forthwith comply with such provisions or this permit shall be deemed revoked. HAZARDOUS MATERIALS DISCLOSURE 0 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. EPA LEAD -SAFE DISCLOSURE 0 An EPA Lead -Safe Certified Renovator will be responsible for this project. Certified Firm Name: Firm Certification No: No EPA Lead -Safe Certified Firm is required for this project. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued (Section 8172, Civil Code). ❑Yes No No Lender CAT Lender's Name: Lender's Address: APPLICATION 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, judgements, 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 CA e tino unici al Code Section 9.18. 9/29/2020 Signature "�' Date 6A8173754FE9478... EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 12 MONTHS AFTER ITS ISSUANCE, OR IF THE WORK AUTHORIZED ON THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF 12 MONTHS AFTER THE TIME THE WORK IS COMMENCED.