B-2016-3264CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR.
PERMIT NO: B-2016-3264
10380 N STELLING RD CUPERTINO, CA 95014-1644 (326 30 092)
JONATHAN WEI CHIN
SU
CUPERTINO, CA 95014
OWNER'S NAME:
DATE ISSUED: 07/26/2017
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO'
License Class 5 Lic. #681633
Contractor JONATHAN )NEI CHIH SI i Date 12/31/2017
X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RESIDENTLAL — COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION
CONSTRUCT (I) TWO STORY SFD (3202 SF); ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
(439 SF); PORCH (677 SF)
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
Sq. Ft Floor Area: 3641
Valuation: $600000.00
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
326 30 092
R-3 (Custom),R-3 (Custom),U (Private Gar /Ag Bldg),U
representatives of this city to enter upon the above mentioned property for
(Private Gar /Ag Bldg)
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 WORK IS NOT STARTED
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the C Municipal Code, ction 9.18.
!Date
180 DAYS FROM LAST CALLED INSPECTION.
Signature 7 17
Issued by Jasmine Archbold
OWNER-BUIL DER DECLARATION
Date: 07/26/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE -ROOFS:
u. I, as owner of the property, or my employees with wages as their sole
All roofs shall be inspected prior to any roofing 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:
Date: 7/26/2017
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
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
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, Sectio�25505,25533,25534.
be deemed revoked.
APPLICANT CERTIFICATION
Owner or authorized agent:
I certify that I have read this application and state that the above information is
Date: 7/26/2017
correct. I agree to comply with all city and county ordinances and state laws
N N 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 712MO17
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3264
10380 N STELLING RD CUPERTINO, CA 95014-1644 (326 30 092) HOMESTEAD
CONSTRUCTION INC
CUPERTINO, CA 95014
OWNER'S NAME:. DATE ISSUED: 07/26/2017
OWNER'S PHONE: PHONE NO: (408) 255-8999
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #681633
Contractor HOMESTEAD CONSTRUCTION INC Date 11/30/2019 X BLDG _ ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _
MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT (N) TWO STORY SFD (3202 SF); ATTACHED GARAGE
(439 SF); PORCH (677 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV #1 - ELIMINATE POWDER ROOM; REDESIGN BATH 1 &
Compensation, as provided for by Section 3700 of the Labor. Code, for the fAUNDRY ROOM; ADD TUB IN BATH 2; RELOCATE HVAC TO
performance of the work for which this permit is issued. .LAUNDRY ROOM; ADD BOOSTER; ELIMINATE SKYLIGHT FROM
2. I have and will maintain Worker's Compensation Insurance, as provided for by FAMILY ROOM 2; ATTIC ACCESS ELIMINATED FROM GARAGE;
Section 3700 of the Labor Code, for the performance of the work for which this REDUCE WINDOW SIZE (NORTH SIDE); CHASE FOR HVAC ADDED
permit is issued. INSIDE MASTER. S CLOSET, .DRYER VENT SHOWN AT THE CEILING
APPLICANT CERTIFICATION LEVEL; ELECTRIC, GAS, FIRE SPRINKLER PANEL, ELECTRIC
I certify that I have read this application and state that the above DAMPERS ADDED; SHOW CONTINUOUS FAN FROM 1 ST FL
information is correct. I agree to comply with all city and county ordinances POWDER ROOM TO 2ND FL .LANDING - ISSUED 11/02/2018
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for REV #2: REVISION TO STORM DRAIN - ISSUED 11/02/2018
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which Sq. Ft Floor Area: 3641 Valuation: $600000.00
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 Cu �ertaibo Mleipl Code, .Section 9. 18. APN Number: Occupancy Type:
326 30 092 R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U
�
PERMIT EXPIRES IF WORD IS NOT STARTED
I hereby affirm that I am exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
following two reasons: 180 DAYS FROM LAST CALLED INSPECTION.
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) Issued by: Jasmine Archbold
2. I, as owner of the property, am exclusively contracting with licensed Date: 07/26/2017
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: RE-ROOFS:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's All roofs shall be inspected prior to any roofing material being installed. If a roof is
Compensation, as provided for by Section 3700 of the Labor Code, for the installed without first obtaining an inspection, I agree to remove all new materials for
performance of the work for which this permit is issued.
inspection.,
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 Signature of Applicant:
permit is issued. Date: 1.1/2/2018
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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the HAZARDOUS MATERIALS DISCLOSURE
Labor Code, I must forthwith comply with such provisions or this permit shall I have read the. hazardous materials requirements under Chapter 6.95 of the
be deemed revolted. California Health & Safety Code, Sections 25505, 25533, and 25534. I will
APPLICANT CERTIFICATION
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that I have read this application and state that the above information is Health & Safety Code, Section 25532(a) should I store or handle hazardousmaterial. Additionally, should I use equipment or devices which emit hazardous
correct. l agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city air contaminants as defined by the Bay Area Air Quality Management District Ikill maintain compliance with the Cupertino �a�y:C°oChapter 9.1.2 andde,
to enter upon the above mentioned property for inspection purposes. (We) agree Municip
the Health & Safety Code, Sections.-2°53.05, 533 and 4:
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 Owner or authorized agent .,,, -
and will comply with all non-point source regulations per the Cupertino Municipal Date: 11/2/2018
Code, Section 9.18. 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.)
Signature Date 11/2/2018 Lender's Name
Lender's Address
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2016-3264
10380 N STELLING RD CUPERTINO,CA 95014-1644(326 30 092) HOMESTEAD
CONSTRUCTION INC
CUPERTINO,CA 95014
OWNER'S NAME: DATE ISSUED:07/26/2017
OWNER'S PHONE: PHONE NO:(
LICENSED ATR DECLARATION BUILDING PERMIT INFO:
License Class 13 Lic.#681633
Contractor HOMESTEAD CONSTRUCTION INC Date 11/30/2019 X BLDG_ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chaplet 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect• JOB DESCRIPTION:
CONSTRUCT(N)TWO STORY SFD(3202 SF);ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following five declarations: (439 SF);PORCH(677 SF)
r. 1 have and will maintain a certificate of consent to self-insure for Worker's REV#1-ELIMINATE POWDER ROOM;REDESIGN BATH I&
Compensation,as provided for by Section 3700 of the Labor Code,da the LAUNDRY ROOM;ADD TUB IN BATH 2;RELOCATE HVAC TO
performance ofthe work for which this permit is issued, LAUNDRY ROOM;ADD BOOSTER;ELIMINATE SKYLIGHT FROM
z. I Inwood will nmint tin Worker's Compensation lu matinee,as provided for by FAMILY ROOM 2;ATTIC ACCESS ELIMINATED FROM GARAGE;
Section 3700 ofthc Labor Code,for the performance of fhc work for which this REDUCE WINDOW SIZE,(NORTH SIDE);CHASE FOR HVAC ADDED
permit is issued. INSIDE MASTER CLOSET;DRYER VENT SHOWN AT THE CEILING
APPLICANT CERTIFICATION LEVEL;ELECTRIC,GAS,FIRE SPRINKLER PANEL,ELECTRIC
I certify that I have read this application and state that the above DAMPERS ADDED;SHOW CONTINUOUS FAN FROM I ST FL
information is correct.I agree to comply with all city and county ordinances POWDER ROOM TO 2ND FL LANDING
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:3641 Valuation:$600000.00
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. APN.Number: Occupancy Type:
Additionally,the applicant understands and will comply with all non-point 32630 092 R-3(Cmamn),R-3(Custom),U(Private Gar/Ag Bldg),U
source regulations per the Cupertino Municipal Code,Section 9.18. (Private Gar/Ag Bldg)
� .
Signature ✓'- Date 5-17-2018 PERMIT EXPIRES IF WORI{IS NOT STARTED
owrveR-BUILDER DECLARATION 180
180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I ant exempt from the Contractor's License Law for one of the
fallowing two reasons:
r. 1,as owner of the property,or my employees with wages as their sole Issued by:Jasmine Archbold
compensation,will do the work,and the structure is not intended or offered for Date:07/26/2017
sale(Scc.7044,Business&I'micssioas Code)
z. I,as owner of the property,am exclusively contracting with licensed RE-ROOFS:
contractors to construct the project(Scc.7044,Business&Professions Code). All root's shot]be inspected prior to any roofing material being installed.Its roof is
I herebyaffirm under It r ofthe fullowin Ila declarations: installed without first obtaining an inspection,I agree to romove all new materials for
a penalty a perjury one a g
v I have and will maintain a Certificate of Consent toself-insure for Worker's nspectimr,
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Signature of Applicant:
z, Ihave and will maintain Worker's Compensation Insurance,as provided for by Dote:5-17-2018
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I. I certify that in the per 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 ofCalifords.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.f will
Labor Code,1 must forthwith comply with such provisions or this permit shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
be deemed revoked. Health&Safety Code,Section 25532(a)should I store e•handle hazardous
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 Cupertino Municipal Code,Chapter 9.12 and
correct.I agree to comply with all city and county ordinances and state laws the Health&Safety Code,Sections 25505 35533,and 25534.
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agreeto save save Indemnify and keep harmless the City of Cupertino against liabilities. Owner or authorized agent:
judgments,costs,and expenses which may accrue against said City In Date:5-17-2018
consequence of the granting of this permit.Additionally,the applicant understands CONSTRUCTION LENDING AGENCY
and will comply with all non-point source regulations per the Cupertino Municipal I hereby affirm that there is a construction lending agency for the performance
Code,Section 9.18. of work's for which this permit Is issued(Sec.3097,Civ C.)
Lender's Name
Signature Date 5-17-2018 Lender's Address
ARCHITECT'S DECLARATION