B-2017-0106CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0106
10220 STONYDALE DR CUPERTINO, CA 95014-1030 (326 37 025)
ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'S NAME: HYDER ADAM AND SEEMA
DATE ISSUED: 03/23/2017
OWNER'S PHONE: 650-273-0404
PHONE NO: (408) 441-0967
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #909433
ContractorALI'S CONSTRUCTION & REMODELING INC Date 01/31/2018
XBLDG _ELECT XPLUMB
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 LIVING ROOM ADDITION (282 S.F.); COVERED PORCH
I hereby affirm under penalty of perjury one of the following two declarations:
(38 S.F.); REROOF COMPOSITION SHINGLES (18 SQ'S); RELOCATE
1. I have and will maintain a certificate of consent to self-insure for Worker's
WASHER AND DRYER TO GARAGE; REPLACE FURNACE; INSTALL
Compensation, as provided for by Section 3700 of the Labor Code, for the
(N) TANKLESS WATER HEATER; INSTALL STONE VENEER IN
performance of the work for which this permit is issued.
FRONT (63 SQ FT).
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
Sq. Ft Floor Area: 228
Valuation: $30000.00
permit is issued.
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
326 37 025
R-3 (Custom)
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 expp,.�nses which
may accrue against said City in consequence of the grptirS"�f this permit.
PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally, the applicant understands andwill co ply fh all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature? ate 03-23-2017
Issued by: Kim Dunbar
OWNER-BUILDER DECLARAT
Date: 03/23/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
r. I, as owner of the property, or my employees with wages as their sole
installed 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 (Sec.7044, Business & Professions Code).
Date: 03-23-2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management Dist
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapt - .12 an
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 2 4.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent
AppLICANT CERTIFICATION
Date: 03-23-2017 �J
1 certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all nori-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 03-23-2017
Professional