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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