B-2017-1110 •
•
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1110
10412 LAS ONDAS WAY CUPERTINO,CA 95014-3130(369 28 033) ' CALIFORNIA HOME
BUILDERS&DESIGN
INC
SAN JOSE,CA 95112
OWNER'S NAME:
PHONE NO:(408)392-8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
License Class B Lic.#882158 -
Contractor CALIFORNIA HOME BUILDERS&DESIGN INC Date 08/31/2018 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:
FIRST AND SECOND FLOOR ADDITION(967 S.F.);KITCHEN
I hereby affirm under penal of perjury one of the following two declarations: REMODEL(292 S.F.);BATHROOM,REMODEL(108 S.F.);(N)PORCH
1. 1 haven will maint 'n a certificate of consent to self-insure for Worker's (53 S.F.);REMODEL DINING/BEDROOM#4(261 SF) _
omp sat' n,a;pro ided for by Section 3700 of the Labor Code,for the
Js:fon c of t rk for which this permit is issued.
p't I 'ave a will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$240000.00 .
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 28 033 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,�nd expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence a granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant un�ddeeret and w)'l comply9h all non-point
source regulations pe Wm—Cupertino M.I'¢fpa�de -ection 9.18. 180 DAYS FROM LAST
thCALLED INSPECTION.
t na r '._ Date 11/8/2017 Issued by:Abby Ayende
Date: 11/08/2017
• .►ER-B I_D .' IEL• t • _•►
I hereby affirm that I am a empt 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
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: 11/8/2017 i
1
I,;hereby affirm under penalty of perjuryoneof 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 j I I`'
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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
3. I 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
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 Qua-lj_ty_1tgement District I
Worker's Compensation laws of Califomia. If,after making this certificate of will maintain compliance with the Cupertinonicipa ode, hapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Seel-iasis 255 t ,2;533 an' 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ,`.---�-- '
be deemed revoked.
. eawridF or author d nt. a
APPLICANT CERTIFICATION Date:,11/8/2017 'i;
I certify that I have read this application and state that the above information is IAct, R TION NDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constr.ction 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 i(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 11/8/2017 Professional