B-2017-0755 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0755
10252 RICHWOOD DR CUPERTINO,CA 95014-3361(369 08 025) C W BUILDERS INC
• SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED:08/15/2017
OWNER'S PHONE: PHONE NO;(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:,
License Class B Lic.#826394
Contractor C W BUILDERS INC Date 09/30/2018 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 FLOOR REMODEL(1,358 S.F.);ADDITION OF(1,437 S.F.);(N)
I hereby affirm under penalty of perjury one of the following two declarations: COVERED PORCH(187 S.F.);REROOF;TEAR-OFF;INSTALL OSB;
1. I have and will maintain a certificate of consent to self-insure for Worker's COMP SHINGLES(17 SQ);UPGRADE AND RELOCATE ELECTRICAL
ompensation,as provided for by Section 3700 of the Labor Code,for the PANEL TO 200 AMP.
performance of the work for which this permit is issued. DEF#1 -TRUSS CALCS-ISSUED 10/23/2017
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. Sq.Ft Floor Area: 1437 Valuation:$300000.00
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 369 08 025 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 liabilitids,'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
source regulation se,the a ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
f natur- Date 10123/2017 Issued by:ABBY AYENDE
Date:08/15/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two'reasons: ' All roofs shall be inspected prior to any roofing material being installed.If a roof is
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
corimpensation,will do the work,and the structure is not intended or offered for inspection.
•
sale(Sec.7044;Business&Professions Code)
z. I as,owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Scc.7044,Business&Professions Code). Date:10/23/2017
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
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 Cuper' ..Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod• pet• s -15,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, caner or authorized ag.i ' ---
APPLICANT
APPLICANT CERTIFICATION Date:10/23/2017
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 non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 10/23/2017 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0755
10252 RICH WOOD DR CUPERTINO,CA 95014-3361(369 08 025) C W BUILDERS 1NC
SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED:08/15/2017
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class D Lia#828394
Contractor C W BUILDERS INC Date 09130/2018 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 Dlvision 3 a]the Business&Professions Code and that my
license is in fall fares and effect. JOB DESCRIPTION:
1 ST FLOOR REMODEL(1,358 ST.);ADDITION OF(1,437 S.F.);(N)
I hereby affirm aider penalty of perjury one of the fi lawing two declarations: COVERED PORCH(187 S.F);REROOF;TEAR-OFF;INSTALL OSB;
s. 1 have and will maintain a certificate of consent toself-insure for Worker's COMP SPANGLES(1 7 SQ);UPGRADE AND RELOCATE ELECTRICAL
Compensation,as provided for by Section 3700 of the Labor Code,for die PANEL TO 200 AMP.
prrfonnance of the work for which this permit is issued. DEF#1-TRUSS CALCS-ISSUED 10/23/2017
C12 have and will maintain Worker's Compensation Insurance,as provided for by REV#1-CHANGE DOOR AND WINDOW HEIGHT;ENLARGE
Section 3700 of the Labor Code,for the performance of the work for which this KITCHEN WINDOW;(3)SKYLIGHTS;(N)GUARD RAIL-ISSUED
permit is issued. 5/22/2018
APPLICANT CERTIFICATION Sy.Ft Floor Arco:1437 Valnaten:$300000.00
I certify that I have read this application and state that the above
information incorrect.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize APN Number: Ocetimney'ypc:
representatives of this city to enter upon the above mentioned property for 369 08 025 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 WORK IS NOT STARTED
Additionally;the app' t understands and will comply with all non-point
source regulatio per 3Etino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signet a Date 5/22/2018
Issued by:ABBY AYENDE
OWNER-BUILDER DECLARATION Date:08/IS/2017
1 hereby affirm that I znr exempt hrom the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
r. I,as owner of the property,or ney employees with wages as their sole All roofs shall be inspected prior to airyroofing material being installed.If a north;
compensation,will do the work,and the structure is i,t intended ce offered for installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) inspection.
z. 1,as owner of the property,am exclusively contracting with licensed
contractors to coast net the project(3ec.7044,Business&Professions Code), Signature o£Applicant
1 hereby affirm under penalty of perjury one of the following three declarations: Date:5/22/201
r. I have and will maintain a Certificate of Consent to self-insure far 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 Bre work go which this permit is issued,
z. 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 Bre hazm dons materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
a. I certify that in the performance of the wok 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 1 store or handle hazardous
Worker's Compensation laws of California.If,alter making this certificate of material.Additionally,should 1 use equipment or devices which emit hazardous
exemption,1 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 midmain complimice with the Cupertino Municipal Code,Chapter 9.12 and
be deemed revoked. the Health&Safety Code,S%iorn"71505,25533,end 25534.
enor authorized agC' --''
I certify that I have read this application and state that the above information is Date:5/2212018 C_--
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION 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 complywith 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 Data 5/22/2018
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT 1
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0755
10252 RICHWOOD DR CUPERTINO, CA 95014-3361 (369 08 025) C W BUILDERS INC
SARATOGA, CA 95070
2y�/\uTl` �!
OWNER'S PHONE:
License Class 51 Lic. #1328394
Contractor C W BUILDERS INC Date 09%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 maintairi a certificate of consent to self -insure for Worker's
Compensation, as provided for bye 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
J Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
certify that I have read this application and state that the above
information is correct. I agree to comply y ith 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 pe7the_Goertino Municipal Code, Section 9.18.
Date 08-15-2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from they Contractor's License Law for one of the
following two reasons:
t. I, as owner of the property, or mylemployces with wages as their sole
compensation, will do the work, d 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).
i
I hereby affirm under penalty of perjury one of the following three declarations:
t. I have and will maintain aCertificate 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
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 Califomia. 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.
I certify that I have read this application t
correct. I agree to comply with all city an
relating to building construction, and her
to enter upon the above mentioned prop
to save indemnify and keep harmless the
judgments, costs, and expenses which'n
consequence of the granting of this pern
and will comply with all non -point source
Code, Section 9.18.
id state that the above information is
county ordinances and state laws
3y authorize representatives of this city
rty for inspection purposes. (Vile) agree
City of Cupertino against liabilities,
3y accrue against said City in
t. Additionally, the applicant understands
egulations per the Cupertino Municipal
Date 08-15-2017
ISSUED: 08/15/2017
PHONE NO: (
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
1ST FLOOR REMODEL (1,358 S.F.); ADDITION OF (1,437 S.F.); (I)
COVERED PORCH (187 S.F.); REROOF; TEAR -OFF; INSTALL OSB;
COMP SHINGLES (17 SQ); UPGRADE AND RELOCATE ELECTRICAL
PANEL TO 200 AMP.
Sq. Ft Floor Area: 1437 1 Valuation: $300000.00
APN Number: Occupancy Type:
369 08 025 1 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Kim Dunbar
RE -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: 08-15-2017
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 Management District I
will maintain compliance with the CupertilLo Municipal Code, Chapter 9.12 and
the Health & Safety Code, s , 25533, and 25534.
Owner or authorized a
Date: 08-15-2017
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
understand my plans shall be used as public records.
Licensed
Professio