B-2017-2117 CITY OF CUPERTINO BUILDING PERMIT
.BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2117
10133 RIEDEL PL CUPERTINO,CA 95014-2337(316 21 061) S N C CONSTRUCTION
SAN MARTIN,CA
95046
OWNER'S NAME: DATE ISSUED:04/02/2018
OWNER'S PHONE: PHONE,NO:(408)265-4085
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class H Lic.#839163 X BLDG X ELECT LY,PLUMB
Contractor S N C CONSTRUCTION Date 05/31/2018 —
I hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing —MECH$RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fnll force and effect. JOB DESCRIPTION:
FIRST FLOOR-KITCHEN REMODEL(240 SF)REMODEL OTHER
I hereby affirm under penalty of perjury one of the following two declarations: COMMON AREA(615 SF),NEW WINDOWS(2),NEW SLIDING
1. I have and will maintain a certificate of eenscnrto self-insure for Worker's DOOR(1),SKYLIGHTS(5);SECOND FLOOR ADDITION-MASTER
�/ ryompensation,as provided for by Section 3700 of the Labor Code,for the BEDROOMS(2)(732 SF);PANEL UPGRADE(200 AMP);RE-ROOF;
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I trove and will maintim Worker's Compenastiou Insurance,as provided for by NEW GAS LINE(1);NEW TANK-LESS WATER HEATER(GARAGE);
Section 3700 of the Labor Code,for the performance of the work for which this REPLACE SIDING WITH STUCCO(200 SF)
permit is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$400000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31621061 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 regula ions per the Cupe rno Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature D to 4/2/2018 Issued by:Jasmine Archbold
Data:04/02/2019
OWNER-RUIL ER DECLARATION
I hereby affirm that I at exempt from the Contractor's License Law far one of the RE-120OFS•
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 nspection,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 Cade)
I I,as owner of the property,not exclusively contracting with licensed Signature ofApplicanc
contractors to consuuct the project(Sea 7044,Business&Professions Code), Dale:4/2/2018
1 hereby affirm under penalty of perjury one of the following throe declarations:
r. 1 have and will maintain a Certificate of C.nscru to self-insure Far 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 I have read the hazardous materials requirements tinder Chapter 6.95 of the
Section 3700 of the Labor Code,tar the performance o£the work for which this California health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued, 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(x)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 m-devices which emit hazardous
Worker's Compensation laws ofCalifaruia.If,after making this certificate of air O ntnmmants as defined by the Bay Area Ah-Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Munici a Code,Chapter 9.12 and
Labor Cade,l must forthwith comply with such provisions or this permit shall the health&Snfety C it Sections 255U5, 5 33,and 5534.
be deemed revoked.
Owner or authorized agentt
APPLICANT CER'1'IRICA'1'lON Date:4/2/2018
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 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 ARCHI'TECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 4/2/2018 Licensed
Professional