B-2016-2676CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: _
CONTRACTOR:
PERMIT NO: B-2016-2676
-861 ROSE BLOSSOM DR CUPERTINO, CA 95014-4263 (359 03 047)
PRESTIGE PAINTING
& HOME
IMPROVEMENTS
SAN JOSE, CA 95120
OWNER'S NAME: JUNAID ASKER AND SHAHIDA TRUSTEE
DATE ISSUED: 01/13/2017
OWNER'S PHONE: 408-664-8348
PHONE NO: (408) 446-5244
NTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Ja Lic. #761003
Contractor PRESTIGE PAINTING & HOME IMPROVEMENTS Date 04/30/2017
X BLDG —ELECT _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:
1ST FLOOR BEDROOM/GARAGE ADDITION (1,122 S.F.); REMODEL
I hereby affirm under penalty of perjury one of the following two declarations:
(1,817 S.F.); REROOF; INSTALL TILES - (25 SQ); REPLACE FURNACE
t. I have and will maintain a certificate of consent to self -insure for Worker's
(ATTIC) AND RELOCATE A/C TO BACK YARD
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
jpI 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: 1122
Valuation: $135000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
359 03 047
R-3 (Custom),R-3,(Custom),U (Private Gar /Ag Bldg),U
representatives of this city to enter upon the above mentioned property for
(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 n consequence of the granting of this permit.
PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally, the applic under tands and will comply with all non -point
source regulations pe the Cup !no Municipal Code, Section 9.18.
WITffiN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature *" i' Date 1/13/2017
Issued by: Kim Dunbar
OWNE_ERDECLARATIONDate:
01L13/2017
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 of Applicant:
Date: 1/13/2017
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
AL • 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. I 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
a. 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 Are7A Quahty Management District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertifiq Municipal, Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, Sections 23505,_15 3, and 25534.
be deemed revoked. C�_
'
APPLICANT CERTIFICATION
owner or authorized agent:
I certify that I have read this application and state that the above information is
Date: 1/13/2017
correct. I agree to comply with all city and county ordinances and state laws
CON TRU(;1J LENDING AGENCY
I hereby affirm that there is struction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
of work's for which this peck 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 1/13/2017
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2676
861 ROSE BLOSSOM DR CUPERTINO, CA 95014-4263 (359 03 047) PRESTIGE PAINTING
& HOME
IMPROVEMENTS
SAN JOSE, CA 95120
OWNER'S NAME: JUNAID ASKER AND SHAHIDA TRUSTEE
OWNER'S PHONE: 408-644-8348
License Class @ Lic. #761003
Contractor PRESTIGE PAINTING & HOME IMPROVEMENTS Date 04/30/2017
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:
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
,16performance of the work for which this permit is issued.
'pz. 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 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 ' iii , judgments, costs, and expenses which
may accrue against sa' City in 9brisequence of the granting of this permit.
Additionally, the appy ant underAtands and will comply with all non -point
source regulations p r the Cupertino Municipal Code, Section 9.18.
Date 6/2/2017
I hereby affsrfn 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 sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
z. 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.
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
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.
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.
Signature Date 6/2/2017
DATE ISSUED: 01/13/2017
PHONE NO: (408) 446-5244
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
1ST FLOOR BEDROOM/GARAGE ADDITION (1,122 S.F.); REMODEL
(1,817 S.F.); REROOF; INSTALL TILES - (25 SQ); REPLACE FURNACE
(ATTIC) AND RELOCATE A/C TO BACK YARD
DEF #1 - ROOF TRUSS - ISSUED 6/2/2017
REV #1 - (I) TEMPORARY POWER POLE (200 AMPS) - ISSUED
6/1/2017
Sq. Ft Floor Area: 1122 1 Valuation: $135000.00
APN Number: Occupancy Type:
359 03 047 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
Date: 01/13/2017
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 Applicant:
Date: 6/2/2017
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) sho iise-or h le hazardous
material. Additionally, should I use equipmen r devices which pinit hazardous
air contaminants as defined by the Bay Area Airily Mana went District I
will maintain compliance with the Cupertino Municipa d Chapter 9.12 and
the Health & Safety Code, Sections y
05, 2553 , a 25534.
Owner or authorized agent:
Date: 6/2/2017
I hereby affirm that there is a constr on lending agency for the performance
of work's for which this permit' 'i ed (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2676
861 ROSE BLOSSOM DR CUPERTINO, CA 95014-4263 (359 03 047)
PRESTIGE PAINTING
& HOME
IMPROVEMENTS
SAN JOSE, CA 95120
OWNER'S NAME: JUNAID ASKER AND SHAHIDA TRUSTEE
DATE ISSUED: 01/13/2017
OWNER'S PHONE: 408-644-8348
PHONE NO: (408) 446-5244
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #761003
Contractor PRESTIGE PAINTING & HOME IMPROVEMENTS Date 04/30/2017
X BLDG X ELECT —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:
1 ST FLOOR BEDROOM/GARAGE ADDITION (1,122 S.F.); REMODEL
I hereby affirm under penalty of perjury one of the following two declarations:
(1,817 S.F.); REROOF; INSTALL TILES - (25 SQ); REPLACE FURNACE
1. I have and will maintain a certificate of consent to self -insure for Worker's
(ATTIC) AND RELOCATE A/C TO BACK YARD
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(2/17/17) DEF #1 - ROOF TRUSS
1. I have and will maintain Worker's Compensation Insurance, as provided for by
REV #1 - (I) TEMPORARY POWER POLE (200 AMPS) - ISSUED
Section 3700 of the Labor Code, for the performance of the work for which this
6/1/2017
permit is issued.
APPLICANT CERTIFICATION
Sq. Ft Floor Area: 1122
Valuation: $135000.00
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
359 03 047
R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U
representatives of this city to enter upon the above mentioned property for
(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 Qty in consequence of the granting of this permit.
Additionally, the applica 'f understands and will comply with all non -point
PERMIT EXPIRES IF WORK IS NOT STARTED
source regulations per llte Cupertino Municipal Code, Section 9.18.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/1/2017
Issued by: ABBY AYENDE
OWNER -BUILDER DECLARATION
Date: 01/13/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE -ROOFS:
t. I, as owner of the property, or my employees with wages as their sole
All roofs shall be inspected prior to any roofmg material being installed. If a roof is
compensation, will do the work, and the structure is not intended or offered for
installed without fust 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 of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations:
Date: 6/1/2017
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
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
3. 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
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
the Health & Safety Code, Sectionk25505, 25533, and 25534.
be deemed revoked.
--
APPLICANT CERTIFICATION
Owner or authorized agent:
I certify that I have read this application and state that the above information is
Date: 6/1/2017 f '
correct. I agree to comply with all city and county ordinances and state laws
CONSTRUCTION LENDING AGENCY
relating to building construction, and hereby authorize representatives of this city
I hereby affirm that there is a c9ristruction 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 6/1/2017
Licensed