B-2017-0143CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: I PERMIT NO: B-2017-0143
10131 ALHAMBRAAVE CUPERTINO, CA 95014-1203 (326 23 027) J B S CONSTRUCTION
SARATOGA, CA 95070
OWNER'S NAME: DV ALHAMBRAAVE LLC
OWNER'S PHONE: 408-594-5725
LICENSED CONTRCTOR'SDECLARATION
License Class A.B. C-29 Lic. #980527
Contractor J B S CONSTRUCTION Date 01/31/2017
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
'ith Section 7000) of Division 3 of the Business & Professions Code and that my
cense 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
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.
A_"LICANT 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 3/26/2017
ISSUED: 01/26/2017
NO: (408) 390-5577
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
_ MECH,X RESIDENTLAI. _ COMMERCIAL
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 (Sce.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.
Date 3(26/2017
JOB DESCRIPTION:
(N) TEMPORARY POWER POLE (200 AMI')
Sq. Ft Floor Area: I Valuation: $500.00
APN Number: Occupancy Type:
326 23 027
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: 01/26/2017
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 now materials for
inspection.
Signature of Applicant:
Date: 1/26/2017
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(x) 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 2$505,25533, and 25534.
Owner or authorized agent:
Date: 1/2612017
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 D • .ZA AR TION
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
.-2 _ of (4
GENERAL PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • building(a-)cupertino.org
❑PLUMBING ❑MECHANICAL ELECTRICAL EIMISCELLANEOUS
PROJECTADDRESS 16131 A LP A M L3ZA A Ve--
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OWNER NAME V A I- HAOMUA A 11461-1-cJE-MAIL
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USE OF RISFI).rDITPLEX 0 MULTI-F.A2,I]LY PROJECT INWILDLAND El YES PROJECT IN ❑ YES
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DESCRIPTION OF 'WORK
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TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's be!half. I have read this
application and the information I have provided is correct. I have read the Description of)ATork and verify it is accurate. I agree to comply with all applicable local
ordinances and state lawsyclating to build' nstruction. I authorize (ep, resentatives of Cupertino t . o enter the above -identified property for inspection.purposes.
Signature ofApplicant/Agent:. Date:
SUPPLENIENTAL INFORMATION REQUIRED
-OVER THE -COUNTER""
STxN'
A4EPNlisc.4pp_,2011.doc revised 06121111