B-2017-1441 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1441
7518 Rainbow Dr Cupertino,CA 95014(366 11 046) U S CREATIVE
BUILDER
SAN JOSE,CA 95134
OWN hijit YAnd Gouri Abhijit DATE ISSUED:08/29/2017
OWNER'S PHONE:408-904-9941 PHONE NO:(408)382-9550
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: -
License Class B Lic.#1025687
Contractor U S CREATIVE BUILDER Date 04/30/2019 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:
REMOVED FIRE PLACE&PATCH REPAIR;INSTALL(N)RECESSED
perjury CEILING LIGHTS(28);REMOVE LOAD BEARING WALL
I hereby affirm under penalty ofone of the followingtwo declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's
A ,mpensation,as provided for by Section 3700 of the Labor Code,for the
1M`L) erformance 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. Sq.Ft Floor Area: Valuation:$30000.00
' . 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 366 11 046.
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 Ci 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 regulationsper the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
'
u' nature , t "`k... _ Date 8/29/2017 Issued by:Abby Ayende
dr ,
Date:08/29/2017
OWNER-BUILDER DECLARATION •
I hereby affirni'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 roofmg,material being installed.If a roof is
1. blas 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
inspection.
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 Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:8/29/2017
I hereby affirm'under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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
Sectionr3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permtt is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify'that in the performance of the work for which this permit is issued,I
material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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,Sections 25 05,25533,and 25534.
Labor Code:I must forthwith comply with such provisions or this permit shall � "
be deemed revoked. wner or authorized agent: /,W.4 t
APPLICANT CERTIFICATION Date:8/29/2017
I certify that,I have read this application and state that the above information is CONSTRUCTION L ND G GENCY
correct.I agree to comply with all city,and county ordinances and state laws I hereby affirm that there is a construction t ding 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.
Signature Date 8/29/2017 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1441
7518 Rainbow Dr Cupertino, CA 95014 (366 11 046) U S CREATIVE
BUILDER
SAN JOSE, CA 95134
OWNER'S NAME: Abhijit Y And Gouri Abhijit I I DATE ISSUED: 08/29/2017
OWNER'S PHONE: 408-904-9941
t o s' t .. I - #ila
License Class B Lic. #1025687
Contractor U S CREATIVE BUILDER Date 04/30/2019
1 hereby affirm that 1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
t. 1 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.
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 01/116/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
1 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
Compensation, as provided for by Section 3700 of the Labor Code, for the
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.
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.
Signature Date 01/116/2018
PHONE NO: (408) 382-9550
BUILDING PERMIT INFO:
X BLDG X ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REMOVE FIRE PLACE & PATCH REPAIR; INSTALL (N) RECESSED
CEILING LIGHTS (28); REMOVE LOAD BEARING WALL
REV #1 - (E) FIRE PLACE TO REMAIN -ISSUED 01/16/2018
Sq. Ft Floor Area: I Valuation: $30000.00
APN Number: Occupancy Type:
366 11046
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Avende
Date: 08/29/2017
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: 01/116/2018
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 Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date: 01/116/2018
I hereby affirm that there is a construction ending 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