B-2017-0415 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: s CONTRACTOR: PERMIT NO:B-2017-0415
7635 HOLLANDERRY PL CUPERTINO,CA 95014-5070(362 26 068) NEWHOME
CONSTRUCTION
FREMONT,CA 94539
OWNER'S NAME: DATE ISSUED:06/26/2017
OWNER'S PHONE: PRONE NO:(408)421-9808
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class j3 Lic.#832709
Contractor NEWHOME CONSTRUCTION Date 02/28/2018 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 FLOOR ADDITION OF(1084 S.F.);PORCH(50 S.F.);INTERIOR
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL OF(E)RESIDENCE AND GARAGE(1583 S.F.);INSTALL
1. I have and will maintain a certificate of consent to self-insure for Worker's (N)TANKLESS WATER HEATER;INSTALL(N)FURNACE IN ATTIC;
.mpensation,as provided for by Section 3700 of the Labor Code,for the UPGRADE ELECTRIC PANEL;INSTALL INTERIOR DRAIN PIPES
performance of the work for which this permit is issued. FOR FUTURE GREY WATER SYSTEM UNDER SEPARATE PERMIT.
•...6 I have and will maintain Worker's Compensation Insurance,as provided for by
4 t Section 3700 of the Labor Code,for the performance of the work for which this REV#1 CHANGE THE TYPE OF THE LIVING ROOM CEILING TO
permit is issued. COFFERED CEILING-ISSUED 8/24/2017
APPLICANT CERTIFICATION Sq.Ft Floor Area:1084 Valuation:$325000.00
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 APN Number: Occupancy Type:
representatives of this city to enter upon the above mentioned property for 362 26 068 R-3(Custom)
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. PERMIT EXPIRES IF WORMS NOT STARTED
Additionally,the applicant ders -netsd't comply with all non-point
source regulations pe a .ert' icipal Co. "=c ion 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR.
180 DAYS FROM LAST CALLED INSPECTION.
Signature„t',._. ' Date 08-24-25017
•
.3 Issued by:Kim Dunbar
i.1 f i d !► Date:06/26/2017
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 roofmg 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:
I hereby affirm under penalty_of perjury one of the following three declarations: Date:08-24-25017
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.
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
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 Munici,:L. ode,C ,ter 9.12 and
be deemed revoked. the Health&Safety Code,Sect':rs i 3 :" d 25 •
APPLICANT CERTIFICATION Owner or authorized agen,+ - '
I certify that I have read this application and state that the above information is Date:08-24-25017
•
correct.I agree to comply withal)city and county ordinances and state laws CON T UCTIO LENDING AGENCY •
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction 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 08-24-25017
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0415
7635 HOLLANDERRY PL CUPERTINO, CA 95014-5070 (362 26 068) NEWHOME
CONSTRUCTION
FREMONT, CA 94539
OWNER'S NAME: DATE ISSUED: 06/26/2017
OWNER'S PHONE: PHONE NO: (408) 421-9808
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #832709
Contractor NEWHOME CONSTRUCTION Date 02/28/2018 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:
1 ST FLOOR ADDITION OF (1084 S.F.); PORCH (50 S.F.); INTERIOR
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL OF (E) RESIDENCE AND GARAGE (15 83 S.F.); INSTALL
�. I have and will maintain a certificate of consent to self-insure for Worker's (N) TANKLESS WATER HEATER; INSTALL (N) FURNACE IN ATTIC;
Compensation, as provided for by Section 3700 of the Labor Code, for the UPGRADE ELECTRIC PANEL; INSTALL INTERIOR DRAIN PIPES
performance of the work for which this permit is issued. .FOR FUTURE GREY WATER SYSTEM UNDER SEPARATE PERMIT.
I have and will maintain Worker's Compensation Insurance, as provided for by' REV'#2 - RELOCATE EXISTING WATER HEATER TO OUTSIDE
Section 3700 of the Labor Code, for the performance of the work for which this CLOSET; (N) OUTSIDE CLOSET - ISSUED 1/16/19
permit is issued. REV #1 CHANGE THE TYPE OF THE LIVING ROOM CEILING TO
APPLICANT CERTIFICATION COFFERED CEILING - ISSUED 8/24/2017
1 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 Sq. Ft Floor Area: 1084 Valuation: $325000.00
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 APN Number: Occupancy Type:
may accrue against said City�jn-c-dhsequue0 e of the granting of fihis permit. 362 26 068 R-3 (Custom)
Additionally, the applicant,uhdamt-rf s and.,'y I comply with all non-point
source regulations er" he�'Cu erkin :M` ii .Se�ct o 9 18.
PERMIT EXPIRES IF WORK IS NOT STARTED
Signat Date 1/16/19 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: Kim Dunbar
following two reasons: Date: 06/26/2017
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
sale (Sec.7044, Business & Professions Code) RE-ROOFS:
2. I, as owner of the property, am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed. If a roof is
contractors to construct the project (Sec.7044, Business & Professions Code), installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
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 Signature of Applicant:
Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 1 16/19
performance of the work for which this permit is issued:
2. I have and will maintain Worker'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.
3. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If, after making this certificate of California Health & S'afety Code, Sections 25505, 25533, and 25534. I will
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 lity __Vagement District I
will maintain compliance with the Cupertino `'�' a Code Ch tetF'9.12 and
APPLICANT CERTIFICATION p p ,n� -� ' P
the Health & Safety Code, Sec r .118,M05,,255", 25534. .....�
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 a
to enter upon the above mentioned property for inspection purposes. (We) agree Date: 6/19
to save indemnify and keep harmless the City of Cupertino against liabilities, CONSTRUCTION LENDING AGENCY
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 1/16/19 ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0415
7635 HOLLANDERRY PL CUPERTINO, CA 95014-5070 (362 26 068)
NEWHOME
CONSTRUCTION
FREMONT, CA 94539
OWNER'S NAME:
PHONE NO: (408) 421-9808
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #832709
Contractor NEWHOME CONSTRUCTION Date 02/28/2018
X BLDG —ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed ander 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 ADDITION OF (1084 S.F.); PORCH (50 S.F.); INTERIOR
I he m under penalty of perjury one of the following two declarations:
REMODEL OF (E) RESIDENCE AND GARAGE (1583 S.F.); INSTALL
717r-haveand will maintain a certificate of consent to self-insure for Worker's
(N) TANKLESS WATER HEATER; INSTALL (I) FURNACE IN ATTIC;
Compensation, as provided for by Section 3700 of the Labor Code, for the
UPGRADE ELECTRIC PANEL.
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
Sq. Ft Floor Area: 1084
Valuation: $325000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
362 26 068
R-3 (Custom)
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 unde�stands and will comply with all non-point
the.,CtfertirMnn4cip Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
source regulations per e,
Signature - - 7
Issued by: Kim Dunbar
%�
OW R-B DER DECLARATION
Date: 06/26/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF-ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
r. I, as owner of the property, or my employees with wages as their sole
installed without fust 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 (Scc.7044, Business & Professions Code)
z. 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: 06-26-2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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
3. 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 Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sectious-; 5533 .
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent—
APPLICANT CERTIFICATION
Date: 06-26-2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING 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 no oint e r ns per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.1.
1 understand my plans shall be used as public records.
Licensed
Signatur Date 06-26-2017
professional