B-2018-0412 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0412
21881 HERMOSAAVE CUPERTINO,CA 95014-2819(357 16 073) GRAND-NEST
CONSTRUCTION
SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED:03/08/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#965419
Contractor GRAND-NEST CONSTRUCTION Date 09/30/2019 X BLDG X 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)TEMPORARY POWER POLE(100 AMP)
I hereby affirm under penalty of perjury one of the following two declarations: REV 41-CHANGE AMP OF POWER POLE TO 200 AMPS-ISSUED
r. 1 have and will maintain a certificate of consent to self-insure for Worker's 5/22/2018
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which ibis permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of[be Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$1000,00
APPLICAN 1.11FICATION
I certify that I have read this appllcatlon 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 357 16 073
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.
//
Signature � Date 5/22/2018 Issued by:AbbyAAyende
Date:03/08/2018
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
r. 1,as owner of the property,or my employees with wages as their sole installed without fust 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:5/22/2018
I hereby affirm under penalty of perjury one of the fallowing 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
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 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
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I stare 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 AU 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
1 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 ARCHITCCT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 5 22 20 8 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRAC'T'OR: PERMIT NO:B-2018-0412
21881 HERMOSAAVE CUPERTINO,CA 95014-2819(357 16 073) GRAND-NEST
CONSTRUCTION
SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED:03/08/2018
OWNER'S PHONE: PHONE NO:(408)891-8059
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lia#�h5 19_
Contractor GRAND-NEST CONSTRUCTION Date 0913012019 X BLDG X ELECT_PLUMB
1 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)TEMPORARY POWER POLE(100 AMP)
I hereby affirm under penalty of penjury one of the following two declarations: REV#1-CHANGE AMP OF POWER POLE TO 200 AMPS-ISSUED
r. 1 have and will maintain a certificate or consent to self-insure for Worker's 5/22/2018
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#2-CHANGE SCOPE OF WORK BACK TO(100 AMP)
performance of the work for which this permit is issued. TEMPORARY POWER POLE-ISSUED 8/21/2018
L i. I have and will maintain Worker's Compensation asurence,as provided for by
Section 3700 of tlic Labor Code,for the performance ofthe work for which this
permit is issued. Sq.Ft Floor Are.: Valuation:$1000.00
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 APIS Number: Occupnncy'rype:
and state laws relating to building construction,and hereby authorize 357 16 073
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,% 180 DAYS FROM LAST CALLED INSPECTION.
Signature. Date 08/21/2018 Issued by:Abby Ayende
Date:03/08/2018
OWNER-RHILDER DECLARATION
I hereby affirm that I am exempt It am 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
n. 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
ampensetimr,will do the work,and the sbvcnure is not intended or offered for inspection.
sato(Sec.7044,Business&Professions Code)
e. 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:08/21/2018
I 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 o£th.Labor Code,for the.
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided far by I have read the Imzardous materials regni narmets 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 25534.1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Permit is issued.
s. I certify that in the purfnnance of the work for which this permit is issued,] Health&Safety Code,Seaton 25532p0 at Id I store m'handle hazardous
shall not employ n arson in an to become emit it tis the material.Additionally,almuld 1 nac equipment or devices which emit hazardous
p y a y p y manner so as J air conamtmuts as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California If,after making this certificate of will mninhnin eomplianae with the Cupertino Municipal Code,Chapter 9.12 sod
exemption,I become subject to the Worker's Compensation previsions of the the Health&Safety Code,Sections 25505,259,and 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall ////
be deemed revoked. Owner or authorized agent:
APPLICANT CERT F[CAr[ON Date:08/21/2018
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 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 08/21/2018 professional