B-2016-2892CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2892
22811 SAN JUAN RD CUPERTINO, CA 95014-3934 (342 22 077) HOMEOWNER
BUILDER
OWNER'S NAME:
OWNER'S PHONE:
License Class Lic. #
Contractor HOMEOWNER BUILDER Date
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.
ISSUED: 05/30/2017
NO:
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE STUCCO WITH WOOD PANEL (300 SF); ADDING ROOF
I hereby affirm under penalty of perjury one of the following two declarations: OVERHANG AT ENTRY AND GARAGE (100 SQ); INSTALL (8) NEW
1. I have and will maintain a certificate of consent to self -insure for Worker's LIGHTS IN FOYER AND OVERHANGS; REPLACE GARAGE DOORS
Compensation, as provided for by Section 3700 of the Labor Code, for the & FRONT DOOR.
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.
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 5/30/2017
OWNER -BUILDER DECLARATION
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 (Sec.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).
Sq. Ft Floor Area: I Valuation: $40000.00
APN Number: Occupancy Type:
34222 077
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: 05/30/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofmg material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ofApl
Date: 5/30/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
L 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.
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 _
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) 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, ti rs 25505, 25533, and 25534.
Owner or authorized agent:
Date: 5/30/2017
CON DING 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 DECLARATION
I understand my plans shall be used as public records.
Licensed
Signature Date 5/30/2017 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2892
22811 SAN JUAN RD CUPERTINO,CA 95014-3934(342 22 077) ATLAS
CONSTRUCTION&
DEVELOPMENT INC
ENCINO,CA 91316
OWNER'S NAME: DATE ISSUED:05/30/2017
OWNER'S PHONE: PHONE NO:(818)728-9611
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#693448
Contractor ATLAS CONSTRUCTION&DEVELOPMENT INC Date 07/31/2018 X BLDG X ELECT _PLUMB
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:
REPLACE STUCCO WITH WOOD PANEL(300 SF);ADDING ROOF
I hereby affirm under penalty of perjury one of the following two declarations: OVERHANG AT ENTRY AND GARAGE(100 SQ);INSTALL(8)NEW
1. I have and will maintain a certificate of consent to self-insure for Worker's LIGHTS IN FOYER AND OVERHANGS;REPLACE GARAGE DOORS
n, pensation,as provided for by Section 3700 of the Labor Code,for the &FRONT DOOR.
,'erformance of the work for which this permit is issued.
ection 3700 of the Labor Code,for the performance of the work for which this FROM SCOPE OF WORK.ISSUED 8/7/2017
permit is issued. REV#2-EXTEND GUTTER AT ENTRY ROOF. ISSUED 8.18.17
• APPLICANT CERTIFICATION REV#3-EXTEND OVERHANG AT GARAGE(6"X 10')ISSUED
I certify that I have read this application and state that the above10/12/2017
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 Sq.Ft Floor Area: Valuation:$40000.00
inspection purposes. (We),agree to save indemnify and keep harmless the
City of Cupertinoagainst liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting pf this permit. APN Number: Occupancy Type:
Additionally,the•applicant understands and will comply with all non-point 342 22 077
sou re regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date 10/12/2017 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: •
Issued by:AbbyAyende
1. I,as owner of the property,or my employees with wages as their sole Date:05/30/2017
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 RE-ROOFS:
contractors to construct the project(Sec.7044,Business&Professions Code). All roofs shall be inspected prior to any roofing material being installed.If a roof is 1
installed without first obtaining an inspection,I agree to remove all new materials for 1
I hereby affirm under penalty of perjury one of the following three declarations: inspection.
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 Signature of Applicant:
performance,of the work for which this permit is issued. Date:10/12/2017
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Worker's Compensation laws of California. If,after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the
exemption,I become subject to the Worker's Compensation provisions 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
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous
APPLICANT CERTIFICATION
air contaminants'as defined by the Bay Area Air Quality Management District I
I certify that I have read this application and state that the above information is will maintain compliance with the Cupe ino Municipal de,Chapter 9.12 and
the Health&SafetyCode, a ion U 533 and 25534.
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)agreener or authorized agent:
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:10/12/2017
irr
judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY
consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.) ,
Code,Section 9.18. Lender's Name ,I
Lender's Address 'I
Signature Date 10/12/2017
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2892
22811 SAN JUAN RD CUPERTINO, CA 95014-3934 (342 22 077)
ATLAS
CONSTRUCTION &
DEVELOPMENT INC
ENCINO, CA 91316
OWNER'S NAME:
PHONE NO: (818) 728-9611
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 3 Lie. #693448
Contractor ATLAS CONSTRUCTION & DEVELOPMENT INC Date 07/31/2018
X BLDG X ELECT _ PLUMB
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:
REPLACE STUCCO WITH WOOD PANEL (300 SF); ADDING ROOF
I hereby affirm under penalty of perjury one of the following two declarations:
OVERHANG AT ENTRY AND GARAGE (100 SQ); INSTALL (8) NEW
1. I have and will maintain a certificate of consent to self-insure for Worker's
LIGHTS IN FOYER AND OVERHANGS; REPLACE GARAGE DOORS
Compensation, as provided for by Section 3700 of the Labor Code, for the
& FRONT DOOR.
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
I��m ' ;,F� D4U IZTAPyEN * It00 ( 1 838. 17
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $40000.00
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
and state laws relating to building construction, and hereby authorize
342 22 077
342
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against,said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulation art Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature° Date
Issued by: SEAN HATCH
Date: 05/30/2017
OWNER-BUILDER DECLARATION
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:
1. - 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 ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date:
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
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
a. 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
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants 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 o Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety C e, Sec ions 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent: I
APPLICANT CERTIFICATION
Date:
I certify that I have read this application and state that the above information is
CONSTRUCTION L NDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and;hereby authorize representatives of this city
of work'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.
Licensed
Signature Date
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUELDING ADDRESS:
22811 SAN JUAN RD CUPERTINO, CA 95014-3934 (342 22 077)
CONTRACTOR: i PERMIT NO: B-2016-2892
CONSTRUCTION &
DEVELOPMENT INC
ENCINO, CA 91316
OWNER'S NAME:
I PHONE NO: (818) 728-9611
License Class a Lie. # 96MA4$
Contractor ATLAS CONSTRUCTION & DEVELOPMENT INC Date 07/31/2018
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:
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
4fjof the work for which this permit is issued.
ave 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.
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 regulati=CupertinoiMunicipal Code, Section 9.18.
Signatur. ..Date 08/07/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 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).
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE STUCCO WITH WOOD PANEL (300 SF); ADDING ROOF
OVERHANGAT ENTRY AND GARAGE (100 SQ); INSTALL (8) NEW
LIGHTS IN FOYER AND OVERHANGS; REPLACE GARAGE DOORS
& FRONT DOOR.
REV #1 -EXTEND OVERHANG AT GARAGE; REMOVE (I) PARAPET
FROM SCOPE OF WORK.
Sq. Ft Floor Area: I Valuation: $40000.00
APN Number: Occupancy Type:
342 22 077
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: 05/30/2017
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 ofApplicant:
Date: 08/07/2017
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 ALL ROOF COVERINGS TO BE CLASS "A"
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.
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 08/07/2017
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) 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 C ertino Municipal Code, Chapter 9.12 and
the Health & Safety Code ec ' s , 25533, and 25534.
Owner or authorized agent
Date: 08/07/2017 Itw
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 DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional