B-2017-1020CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1020
20930 FARGO DR CUPERTINO, CA 95014-1806 (326 30 113)
KUBRO
CONSTRUCTION
CUPERTINO, CA 95014
OWNER'S NAME:
DATE ISSUED: 01/10/2018
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class @ Lic. #960307
Contractor KUBRO CONSTRUCTION Date 04/30/2019
x BLDG X ELECT X 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:
1 ST FLOOR FAMILY ROOM ADDITION (490 SF); (N) 200
I hereby affirm under penalty of perjury one of the following two declarations:
ELECTRICAL PANEL AND (N) DEDICATED GAS METER FOR THE
m. I have and will maintain a certificate of consent to self -insure for Worker's
(E) IN-LAW UNIT; (N) PORCH (57 SF)
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
-TVI have and will maintain Worker's Compensation Insurance, as provided for by
-1 Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area: 490
Valuation: $60000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
32630 113
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, 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.
Signat _ ate 1/10/2018
Issued by: AbbyAvende
�-_� L;A;R�A�
Date: 01/10/2018
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
m. 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: 1/10/201
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 2553
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized age
APPLICANT CERTIFICATION
Date: 1/10/2018
I certify that I have read this application and state that the above information is
CON "ON L&DING 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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 1/10/2018
professional
i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1020
20930 FARGO DR CUPERTINO,CA 95014-1806(326 30 113) KUBRO
CONSTRUCTION
CUPERTINO,CA 95014
OWNER'S NAME: DATE ISSUED:01/10/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#960307
Contractor KUBRO CONSTRUCTION Date 04/30/2019 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
1 ST FLOOR FAMILY ROOM ADDITION(490 SF);(N)200
I hereby affirm under penalty of perjury one of the following two declarations: ELECTRICAL PANEL AND(N)DEDICATED GAS METER FOR THE
L I have and will maintain a certificate of consent to self-insure for Worker's (E)IN-LAW UNIT;(N)PORCH(57 SF)
ompensation,as provided for by Section 3700 of the Labor Code,for the REV#1-ALTERATION TO ROOF-ISSUED 3/28/2018
performance of the work for which this permit is issued. REV#2-REVISE RELOCATING OF SKYLIGHT-ISSUED 08/30/2018
I have and 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:490 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 32630 113 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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatu Date 08/29/2018 Issued by:Abby ende
Date:01/10/2018
OWNE ER 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:08/29/2018
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
certificate of air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this
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 a
APPLICANT CERTIFICATION Date:08/29/2018
I certify that I have read this application and state that the above information is T Y
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.bNthe 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 08/29/2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1020
20930 FARGO DR CUPERTINO,CA 95014-1806(326 30 113) KUBRO
CONSTRUCTION
CUPERTINO,CA 95014
OWNER'SNAME: DATE ISSUED:01/10/2018
OWNER'S PHONE: PHONE NO;(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#960307
Contractor KUBRO CONSTRUCTION Date 04/30/2019 X BLDG X ELECT X PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
IST FLOOR FAMILY ROOM ADDITION(490 SF);(N)200
I hereby affirm under penalty of perjury one of the following two declarations: ELECTRICAL PANEL AND(N)DEDICATED GAS METER FOR THE
1. 1 have and will maintain a certificate of consent to self-insure for Worker's (E)IN-LAW UNIT;(N)PORCH(57 SF)
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#I-ALTERATION TO ROOF-ISSUED 3/28/2018
erformance of the work for which this permit is issued.
1 nave and will maintain Worker's Compensation Insurance,as provided for by
action 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area:490 Valuation:$60000.00
APPLICANT C'ETIFICATION
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 stale laws relating to building construction,and hereby authorize 32630 113 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,costs,and expenses which PERMIT EXPIRES IF WORT{IS NOT STARTED
may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additlonally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Cle,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
'g�ure �-"' _ 28 20 8 Issued by:Abby Avende
--
Date:0 1/10/20 18
' -B ILDER1 11 ARATI
I hereby affirm that I am exempt from the Contractor's License Law for one of the BE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
L 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)
z. I,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:03/28/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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
pet furmance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 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 HeaBh&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this penult is issued,[ material.
&Safety Code,Section 25532(a)should I stere or handle hazardous
al.Health Additionally,should 1 use equipment or devices which emit hazardous
so
hall not employ any person in any unner so as to become subject to the h-contaminunts as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,afer making this certificate of win maintain comphianee with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 25505,25533,atiPP34.
Labor Code,I most forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized !—
APPLICANT'CERTIFICATIOtN Date:03/28/2018
I certify that I have read this application and state that the above Information is CON.TR � � DI G A E
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. 1 understand my plans shall be used as public records.
Signature Date 03/28/2018 Licensed
Professional