B-2016-2560 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2560
948 FERNGROVE DR CUPERTINO,CA 95014-4665(375 38 024) HOOD GENERAL
CONTRACTING
PALO ALTO,CA 94306
OWNER'S NAME:
PHONE NO:(760)963-8400
LICENSED CONTRACTOR'S DECLARATION BUILDING.PERMIT INFO:
License Class G Lic.#676339
Contractor HOOD GENERAL CONTRACTING Date 11/30/2018 X BLDG _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:
1ST FLR MASTER BATH ADDITION(69 S.F.);REMODEL(E)
I hereby affirm under penalty of perjury one of the following two declarations: KITCHEN(164 S.F.);REMODEL(E)HALL&MASTER BATHS(83
1. I have and will maintain a certificate of consent to self-insure for Worker's S.F.);REMODEL(E)LIVING RM,MASTER BEDROOM&BEDROOM
Compensation,as provided for by Section 3700 of the Labor Code,for the 2(660 S.F.);REMOVE(E)FP,INSTALL SLIDING GLASS
performance of the work for which this permit is issued. DOOR/WINDOW;ADD 1 (N)WINDOW(BDRM 2),REPLACE FRONT
I have and will maintain Worker's Compensation Insurance,as provided for by DOOR/SIDE WINDOWS&(E)SLIDING GLASS DOOR(LIVINGRM)
Section 3700 of the Labor Code,.for the performance of the work for which this REV#1-STRUCTURAL CONCRETE AND FOUNDATION REVISION;
permit is issued. ADD PADS AND POST BEAM CONNECTIONS-ADDITIONAL
APPLICANT CERTIFICATION DETAILS- (N)SPREAD FOOTING;EXTEND(N)(E)SLAB;ADD
I ertify that'I have read this application and state that the above CONCRETE PADS-ISSUED 9-21-2017
information is correct.I agree to comply,with all city and county ordinances Sq.Ft Floor Area:69 Valuation:$250000.00
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 tosave indemnify and keep harmless the APN Number: Occupancy Type:
City of Cupertino against liabilities,judgments,costs,and expenses which 375 38 024 R-3(Custom)
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands a'd will comply with all non-point
source regulati.: .-r the Cupert''o M nicipal Code,Section 9.18.
-� Date 09-21-2017 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
I . ,''`B ILD R D AST •►
I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by:Abby Avende
following two reasons:. ' ', Date:06/19/2017
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 RE-ROOFS:
sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is
2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for
contractors to'construct the project(Sec.7044,Business&Professions Code). inspection.
I hereby affirm under penalty of perjury one of the following three declarations: -
r. I have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicant:
Compensation,as provided for by'Section 3700 of the Labor Code,for the Date:09-21-2017
performance of the work'for which this permit is issued.
2. I have and will maintain Wo'rker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Section 3700 of the Labor Code,,for the performance of the work for which this
permit is issued. HAZARDOUS MATERIALS DISCLOSURE
s. I certify that in the performance of the work for which this permit is issued,I I have read the hazardous materials requirements under Chapter 6.95 of the
shall not employ'any person in any manner so as to become subject to the California Health&Safety Code,Sections 25505,25533,and 25534. I will
Worker's Compensation laws of California. If,after making this certificate of maintain compliance with the Cupertino Municipal Code,'Chapter 9.12 and the
exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Section 25532(a)should I store or handle hazardous
Labor Code,I must forthwith comply with such provisions or this permit shall material. Additionally,should I use equipment or devices which emit'hazardous
be deemed revoked. air contaminants as defined by the Bay Area Air Quality Manag• ent District I
will maintain compliance with the Cupertino Municipal vide 'hapter 9.12 and
APPLICANTCERTIFICATION the Health&Safety Cod. 'e tions 25505,25. 3, . d 25534.
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 Owner or authorized age, �
Date:09-21-2017 /
to enter upon the above mentioned property for inspection purposes. (We)agree •, � • .it I.
,
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in I hereby affirm that there is a construction lending agency for the performance
consequence of the granting of this permit. Additionally,the applicant understands of work's for which this permit is issued(Sec.3097,Civ C.)
and will comply with'all non-point source regulations per the Cupertino Municipal Lender's Name
Code,Section 9.18. Lender's Address
Signature Date 09-21-2017 ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2560
948 FERNGROVE DR CUPERTINO, CA 9501413665 (375 38 024) HOOD GENERAL
CONTRACTING
PALO ALTO, CA 94306
OWNER'S NAME:
LICENSED CONTRACTOR'S DECLARATION
License Class la Lic. #676339
Contractor HOOD GENERAL CONTRACTING Date 11/30/2018
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
C� performance of the work for which this permit is issued.
r I have and will maintain Worker's Compensation Insurance, as provided for by
l 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 d will comply with all non -point
source regulation per the Cuperti M nicipal Code, Section 9.18.
Signatur Date 6/19/2017
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 (Scc.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).
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.
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 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 6/19/2017
DATE ISSUED: 06/19/2017
NO: (760) 963-8400
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
1 ST FLR MASTER BATH ADDITION (69 S.F.); REMODEL (E)
KITCHEN (164 S.F.); REMODEL (E) HALL & MASTER BATHS (83
S.F.); REMODEL (E) LIVING RM, MASTER BEDROOM & BEDROOM
2 (660 S.F.); REMOVE (E) FP, INSTALL SLIDING GLASS
DOOR/WINDOW; ADD 1 (N) WINDOW (BDRM 2), REPLACE FRONT
DOOR/SIDE WINDOWS & (E) SLIDING GLASS DOOR (LIVINGRM)
Sq. Ft Floor Area: 69 1 Valuation: $250000.00
APN Number: Occupancy Type:
375 38 024 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
RF. -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 new materials for
inspection.
Signature of Applicant:
Date: 6/19/2017
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) 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 Ma agement District I
will maintain compliance with the Cupertino MunicipalCo , Chapter 9.12 and
the Health & Safety
Owner or authorized agent: �'✓"
Date: 6/19/2017
CONSTRUCTI!bN 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
ARC'HITECT'S DECLARRATION
I understand my plans shall be used as public records.
Licensed
Professio