B-2017-0897 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0897
10424 STERLING BLVD CUPERTINO,CA 95014-3832(375 24 003) GILBERT FERNANDEZ
, JR INC
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:08/30/2017
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S.DECLARATION - BUILDING PERMIT INFO:
License Class)3 Lic.#1019550 '
Contractor GILBERT FERNANDEZ JR INC Date 10/31/2018 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:
(N)TWO STORY SFD(2126 SF.)ATTACHED GARAGE(428 SF)
I hereby affirm under penalty of perjury one of the following two declarations: (2)PORCH(610 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's
f ompensation,as provided for by Section 3700 of the Labor Code,for the
4000.erformaiice 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:2126 Valuation:$500000.00
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 375 24 003 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
souroe re•ulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
i.'gnature Date 8/30/2017 Issued by:Abby Ayende
• " Date:08/30/2017
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
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:8/30/2017
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. HAZA DOUS 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 the to • material. Additionally,should I use equipment or devices emit hazardous
air contaminants as defined by the Bay Area Air 1 uality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C,.• Sectio,.25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ner or authorized agent:
APPLICANT CERTIFICATION D` ate:8/30/2017
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 representativescf 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 ofthe granting of this permit. Additionally,the applicant understands
and will complyiwith 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 8/30/2017 Professional •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0897
10424 STERLING BLVD CUPERTINO,CA 95014-3832(375 24 003) GILBERT FERNANDEZ
JR INC
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:08/30/2017
OWNER'S PRONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#10195
Contractor GILBERT FERNANDEZ JE INC Date 1 0/3112 01 8 X BLDG—ELECT_PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby oflirm that I am Itunsed under the provisions at Chapter 9(commencing
with Section 7000)of'Divisfan 3 ofthe Business&professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)TWO STORY SFD(2126 SF.)ATTACHED GARAGE(428 SF)
I hereby agirm under penalty of perjury one of the following two declarations: (2)PORCH(610 SF)
r. I have and will maintain a certificate of consent to self-insure for Worker's REV#4 LANDSCAPE MODIFICATIONS-ISSUED 08/15/2018
Compensation,as provided for by Section 3700 of the Labor Code,for the REVISION#1-CHANGE ROOF FRAMING TO TRUSSES-ISSUED
performance of the work for which this permit is issued. 1/19/2018
is issued,
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Sq.Ft Floor Area:2126 Valuation:$500000.00
Information Is correct.I agree to comply with all city and county ordinances
and slate laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type:
Inspection purposes. (We)agree to save indemnify and keep harmless the 375 24 003 R-3(Custom)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
source regulations per the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature...--- --'�•� 180 DAYS FROM LAST CALLED INSPECTION.
Date 08/15/2018
�_ ...
OWNER BUILDERDECLARATION Issued by:Abby Ayende
Date:08/30/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Following two reasons:
v 1,as owner of the property,or my employees with wages as their sole RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is
sale(Scc.7044,Business&Professions Code) installed without first obtaining airinspection,1 agree to remove all new materials for
z
inspection.
I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(See.7044,Business&Professions Corle),
Signature of Applicann
I hereby affirm under penalty of perjury one of the following three declarations: Date,09/15/2015
r, 1 have and will maintain a Certificate of Consent to scT 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.
x. 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 HAZARDOUS MATERIALS DISCLOSURE
I have and the hazardous materials requirements under Chapter 6.95 of the
permit is issued.
a. California Health&Safety Code,Sections 25505,25533,mad 25534.1 will
1 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 maintain compliance with the Cupertino)shoal I Code, handle
9.12 and the
Health&Safety Code,Section 25532(n)should I store or handle hnznrdous
Worker's Compensation laws of California.If,after making this coniflcale of naterfal.Additionally,should I use equipment m-devices which anift h.—Nons
exemption,l become subject to the Worker's Compensation provisions of the air contnminmrts as defined by the not Arco 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 learned revolved. the Health&Safety
"�
I certify that I have read this application and state that the above Information is Owner or authorized agenta
correct,I agree to comply with all city and county ordinances and state laws Data:08/15/2018
relating to building construction,and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY
to enter upon the above mentioned property for inspection purposes. (We)agree I hereby affirm that there Is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against Iiabillties, of work's for which this permit is issued(Sec.3097,Civ C.)
judgments,costs,and expenses which may accrue against said City In Lender's Name
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 08/15/2018
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0897
10424 STERLING BLVD CUPERTINO,CA 95014-3832(375 24 003) GILBERT FERNANDEZ
JR INC
CAMPBELL,CA 95008
OWNER'SNAME: DATE ISSUED:08/30/2017
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.#1019550
Contractor GILBERT FERNANDEZ JR INC Date 1 0/3112 01 8 2J BLDG—ELECT_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:
(N)TWO STORY SFD(2126 SF.)ATTACHED GARAGE(428 SF)
I hereby affirm under penalty of perjury one of the following two declarations: (2)PORCH(610 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's REVISION#1-CHANGE ROOF FRAMING TO TRUSSES-ISSUED
Compensation,as provided for by Section 3700 of the Labor Code,for the 1/19/2018
performance of the work for which this permit is issued. REV#2-ELEVATIONS/J6 TRUSS CHANGE-ISSUED 6/28/18
C7I have and will maintain Worker's Compensation Insurance,as provided for by REV#3-CHANGE FENCE HEIGHT-ISSUED 6/28/18
/^Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area:2126 Valuation:$500000.00
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 ane Occu
ApN Number;
and state laws relating to building construction,and hereby authorize p y Type:
representatives of this city to enter upon the above mentioned property for 375 24 003 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature �.�� Date 060/18
Issued by:Abby Avende
OWNER-BUILDER DECLARATION Date:08/30/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
fallowing two reasons: RE-ROOFS:
1. I,as owner of the property,or my employees with wages as the¢auto 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 that obtaining an inspection,I agree to remove all new materials for
sale(See.7044,Business&Professions Code) inspection.
z. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant:
Date:06/28/18
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to aelf-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
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 I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued.
California Health&Safety Code,Sections 25505,25533,and 25534.1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 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
Worker's Compensation laws of California.If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION Owner or authorized agent: ��--.�
I certify that I have read this application and state that the above Information Is Date:06/28/18
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 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 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 06/28/18 Licensed
Professional