B-2017-1808 • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: _ PERMIT NO:B-2017-1808
21928 OAKDELL PL CUPERTINO,CA 95014-1161(326 18 048). , ATLAS
CONSTRUCTION&
DEVELOPMENT INC
ENCINO,CA 91316
OWNER'S NAME: LAM CHRIS C AND COLLEEN DATE ISSUED: 10/23/201.7 .
OWNER'S PHONE: PHONE NO:(818)728-961.1
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class'B .Lic.#693448 •
Contractor ATLAS CONSTRUCTION&DEVELOPMENT INC Date 07/31/2018 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
1 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:
KITCHEN REMODEL(305 SF);REMOVE NON-LOAD BEARING
I hereby affirm under penalty of perjury one of the following two declarations: WALLS&POSTS;ADD 24 RECESSED LIGHTS IN DINING AND
1. I have and will maintain a certificate of consent to self-insure for Worker's LIVING ROOM.
' Compensation,as provided for by Section 3700 of the Labor Code,for the
�17erformance of the work for which this permit is issued. REVISION#1: REMOVED WALLS ARE LOAD BEARING. INSTALL
J/ I have and will maintain Worker's.Compensation Insurance,as provided for by SUPPORT FOOTINGS,POSTS,AND BEAMS. ISSUED 11.2.17
Section 3700 of the Labor Code,for the performance of the work for which this REV#2 CHANGE FOOTINGS;REMODEL LIVING ROOM-(320 SF)
permit is issued. ISSUED 11/29/2017
APPLICANT CERTIFICATION Sq.Ft Floor Area: - Valuation:$60000.00 •
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- 326 18 048
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
source(regulations per the Cupertino Municipal Code,Section 9:18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
____
nature / / Date 11/29/2017
Iss •
OWNER-BUILDER DECLARATION Date:ed by2 Abby Ayende
10//23/2017
I hereby,affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
� RE-ROOFS:
t.l 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: : 1,gas owner of the property,am exclusively contracting with licensed
I I', 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: 11/29/2017
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 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. 1 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 Califomia. 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 Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION • °,3; authorized agent:
I certify that I have read this application and state that the above information is new..'1/29/2017
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'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 11/29/2017
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1808
21928 OAKDELL PL CUPERTINO,CA 95014-1161(326 18 048) B
ENCINO,CA 91316
OWNER'S NAME: LAM CHRIS C AND COLLEEN DATE ISSUED: 10/23/2017
OWNER'S PHONE: PHONE NO:(818)728-9611
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.#693448
Contractor B Date 07/31/2018 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:
KITCHEN REMODEL(305 SF);REMOVE NON-LOAD BEARING
I hereby affirm under penalty of perjury one of the following two declarations: WALLS&POSTS;ADD 24 RECESSED LIGHTS IN DINING AND
1. I have and will maintain a certificate of consent to self-insure for Worker's LIVING ROOM.
Compensation,as provided for by Section 3700 of the Labor Code,for the
erformance of the work for which this permit is issued. REVISION#1: REMOVED WALLS ARE LOAD BEARING. INSTALL
ave and will maintain Worker's Compensation Insurance,as provided for by SUPPORT FOOTINGS,POSTS,AND BEAMS. ISSUED 11.2.17
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$60000.00
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 326 18 048
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 understands and will comply with all non-point
source regulationsonper the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ---- Date 11/2/2017 Issued by:Abby Ayende
Date: 10/23/2017
OWNER,BTllLDER 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. 1,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
compensation,will do the work,and the structure is not intended or offered for inspection.
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:11/2/2017
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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date: 11/2/2017
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 11/2/2017 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: • CONTRACTOR: PERMIT NO:B-2017-1808
21928 OAKDELL PL CUPERTINO,CA 95014-1161(326 18 048) ATLAS
CONSTRUCTION&
DEVELOPMENT INC •
ENCINO,CA 91316
OWNER'S NAME: LAM CHRIS C AND COLLEEN DATE ISSUED: 10/23/2017
OWNER'S PHONE: PHONE NO:(818)728-9611
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B:C-36 Lic.#693448
Contractor ATLAS CONSTRUCTION&DEVELOPMENT INC Date 07/31/2018 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:
KITCHEN REMODEL(305 SF);REMOVE NON-LOAD BEARING
I hereby affirm under penalty of perjury one of the following two declarations: WALLS&POSTS;ADD 24 RECESSED LIGHTS IN DINING AND
t. I have and will maintain a certificate of consent to self-insure for Worker's LIVING ROM
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. •
n 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:$60000.00
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 326 18 048
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 understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
ure Date 10/23/2017 - Issued by:Abby Ayende
Date: 10/23/2017
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
t. 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
compensation,will do the work,and the structure is not intended or offered for inspection.
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: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. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
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 1
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 25505,25533,,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. org :