B-2017-0749CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0749
1508 ASTER CT CUPERTINO, CA 95014-5213 (366 16 045) TRIPP CUSTOM
BUILDERS
FREMONT, CA 94539
OWNER'S NAME: I I DATE ISSUED: 01/04/2018 1
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class 1a Lic. #778415
Contractor TRIPP CUSTOM BUILDERS Date 05/31/2018
l 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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
� 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 01/04/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1, 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:
1. 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.
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.
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, 1 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 01/04/2018
PHONE NO: (510) 378-4828
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
1 ST FLOOR ADDITION- STUDY/POWDER RM/LAUNDRY RM (256
S.F.); COVERED ENTRY PORCH (39 S.F.); REMODEL- KITCHEN (200
S.F.); OTHER REMODEL (440 S.F.).
Sq. Ft Floor Area: 256 1 Valuation: $0.00
APN Number: Occupancy Type:
366 16 1 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
Date: 01/04/2018
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: 01/04/2018
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(x) 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: 01/04/2018
CONSTRUCTION LENIIIXGLAGE��
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
I understand my plans shall be used as public records.
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0749
1508 ASTER CT CUPERTINO,CA 95014-5213(366 16 045) TRIPP CUSTOM
BUILDERS
FREMONT,CA 94539
OWNER'S NAME: DATE ISSUED:01/04/2018
OWNER'S PHONE: PHONE NO:(510)378-4828
LICENSED CONTRACTOR'SDECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Uc.#778415 X BLDG_ELECT_PLUMB
Contractor TRIPP CUSTOM BUILDERS Date 05/3112018 —
I herebyaffirm that I am licensed under the provisions o£Chapter 9 —MECH a RESIDENTIAL_COMMERCIAL
a p p (wmmencing
with Section 7000)of Division 3 ofthe Business&Professions Cade and that my
license is in full force and effect. JOB DESCRIPTION:
I ST FLOOR ADDITION-STUDY/POWDER RM/LAUNDRY RM(256
I hereby affirm under penalty of perjury one ofthe following two declarations: S.F.);COVERED ENTRY PORCH(39 S.F,);REMODEL-KITCHEN(200
r. I have and will maintain a certificate of consent to self-insure for Worker's S.F.);OTHER REMODEL(440 S.F.)
Compensation,as provided for by Section 3700 of the Labor Code,for the REVISION#1-LAUNDRY ROOM SIZE AND LAYOUT;(N)SUB-
performance ofthe work for which this permit is issued. PANEL IN LAUNDRY RM;ROOF SUPPORT IN KITCHEN;CHANGES
1 I have and will maintain Worker's Compensation btsurance,as provided for by TO WINDOW AND DOORS IN DINING RM AND STUDY;(N)
Section 3700 of the Labor Code,for the performance of the work for which this FURNACE AND AC UNIT IN ATTIC ABOVE POWDER RM.-ISSUED
permit is issued. 06-08-2018
APPLICANT CERTIFICATION Sq.Ft Floor Area:256 Valuation:$0.00
1 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 366 16 045 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 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.
Signature Date
Issued by:Jasmine Archbold
OWNER-BUILDER DECLARATION Date:01/04/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
t. I,as owner ofthe property,or my employees with wages as their sole A0 roofs shall be inspected prior to any roofing materiel being installed.Its roof is
compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,l agree to remove all new materials for
sale(Sce.7044,Business&Professions Code) inspection.
z. I,as owner ofthe property,.am exclusively contracting with licensed
contractors to construct the project(Sec,7044,Business&Professions Code). Signature o£Applitent:
1 hereby affirm under penalty of perjury one of the fallowing three declarations: Date;
t. I have and will maintain a Certificate of Consent to self-insure for Worker's '
Compensation,as provided for by Section 3700 ofthe Labor Code,for the ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
performance of the work for which this permit is issued.
z I have and will maintain Worker's Compensation Insurance,as In 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 rugair c Bents under Chapter 6.95 of the
Permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534.1 will
s. I certify that in the perfornrmrce of the work for which this permit is issued,Imaintain 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(n)should I store or handle heznrdous
Worker's Compensation laws of California,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 contend...ts 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
be deemed revoked. the IIealth&Safety Code,Sections 25505,25533,and 25534,
APPLICANT CERTIFICATION Owner or authorized agent:
I certify that I have read this application and state that the above information is Date:
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there Is a construction lending agency for the perfo("ante
to enter upon the above mentioned property for inspection purposes. (We)agree of work's for which this permit is issued(Sec.3097,Gv C.)
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
judgments,casts,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 Dale
Licensed
Professional
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