B-2018-0429 CITY OF CUPERTINO BUILDING PERMIT '
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0429
1170 S STELLING RD CUPERTINO CA 95014-5080(362 25 046) OWNER/BUILDER
OWNER'S NAME: DATE ISSUED:06/18/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: '
License Class Lic.#
Contractor OWNER/BUILDER Date. X BLDG _ELECT X PLUMB
X 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:
2ND FLOOR ADDITION(528 SF); 1ST FLOOR REMODEL OTHER(90
I hereby affirm under penalty of perjury one of the following two declarations: SF)GAR CONVERSION/RELOCATE BATHROOM;REMODEL
1. I have and will maintain a certificate of consent to self-insure for Worker's KITCHEN(300 SF);NEW AC UNIT;NEW TANK-LESS WATER
Compensation,as provided for by Section 3700 of the Labor Code,for the HEATER(RELOCATE TO OUTSIDE OF HOUSE);RELOCATED
performance of the work for which this permit is issued. WASHER&DRYER;REPLACE EXISTING WINDOWS(25)LIKE FOR
2, I have and will maintain Worker's Compensation Insurance,as provided for by LIKE TO MEET EGRESS
Section 3700 of the Labor Code,for the performance of the work for which this REV#1-STRUCTURAL CHANGES PER FIELD CONDITIONS-
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Sq.Ft Floor Area:527 Valuation:$127000.00
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 APN Number: Occupancy Type:
inspection purposes. (We)agree to save indemnify and keep harmless the 362 25 046 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
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 2-22-2019
OWNER-BUILDER DECLARATION Issued by:Kim Dunbar
Date:06/18/2018
I hereby affirm that I am exempt from the Contractor's License Law fori one of the
following two reasons:
1, I,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(Sec.7044,Business&Professions Code) installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,am exclusively contracting with licensed inspection.
�" contractors to construct the project(Sec.7044,Business&Professions Code). -
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations: Date:2-22-2019
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
certify that in the performance of the work for which this permit is issued,I California Health&Safety Code;Sections 25505,25533,and 25534. I will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
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 contaminants 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 Health&Safety
correct.I agree to comply with all city and county ordinances and state laws Date:2-22-2019
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 liabilities, of work's for which this permit is issued(Sec.3097,Civ C.)
judgments,costs,and expenses which may accrue against said City in Lenders 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 Lenders Address
Code,Section
/` Date 2-22-2019
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0429
1170 S STELLING RD CUPERTINO,CA 95014-5080(362 25 046) DAVID BAKER
CONSTRUCTION
SAN JOSE,CA 95121
OWNER'S NAME: DATE ISSUED:06/18/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lie.#¢2§342
Contractor DAVID BAKER CONSTRUCTION Date 45/31/2019 X BLDG_ELECT X PLUMB
I herebynMrm that I ant licensed under the provisions of Cha rter 9 X MECH X RESIDENTIAL_COMMERCIAL
Prov ( (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
2ND FLOOR ADDITION(528 SF);1ST FLOOR REMODEL OTHER(90
1 hereby affirm under penalty of perJury one of the following two declarations: SF)GAR CONVERSION/RELOCATE BATHROOM;REMODEL
t. I have and will maintain acertificate of consent to self-insure for Worker's KITCHEN(300 SF);
Compensation,as provided for by Section 3700 of the Labor Code,for the NEW AC UNIT;NEW TANK-LESS WATER HEATER(RELOCATE TO
performance of the work for which this permit is issued. OUTSIDE OF HOUSE);RELOCATED WASHER&DRYER
and will maintain Worker's Compensation htsurance,as provided to,-by REPLACE EXISTING WINDOWS(25)LIKE FOR LIKE TO MEET
Section 3700 of the Labor Code,far the pciformance of the work for which this EGRESS
permit is issued.
APPLICANT CERTIPiCATION Sq.Ft Floor Are.;527 Valuation;ati ;$127000.00
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 36225 046 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 regulation per the a sertlno Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06-18-2018
Issued b/1 Kim Dunbar
Date:06/18/2018
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
t. 1,as owner o£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(Scc.7044,Business&Professions Code)
i. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicand
contructors to construct the project(Sec.7044,Business&Professions Code). Date:06-1.8-2018
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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£o which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation insurance,as provided for by I have read the hez.H.-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. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I. I certify that in the performance of the work for which this permit is issued,l 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 1 use equipment or devices which emit hazardous
Worker's Compensation laws o£California.if,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District 1
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,l must forthwith comply with such provisions or this permit shall the health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked.
Ownet 6-authorized agent:
APPLICANT CERTIFICATION Data:06-18-2018
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 Data 06-18-2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0429
1170 S STELLING RD CUPERTINO,CA 95014-5080(362 25 046) Bandewar Mahesh And
Shilpa M
1170 S Stelling Rd
Cupertino,CA 95014-
5080
OWNER'S NAME: DATE ISSUED:06/18/2018
OWNER'S PHONE: PHONE NO:650-898-2809
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Bandewar Mahesh And Shilpa M Date X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
2ND FLOOR ADDITION(528 SF); 1 ST FLOOR REMODEL OTHER(90
I hereby affirm under penalty of perjury one of the following two declarations: SF)GAR CONVERSION/RELOCATE BATHROOM;REMODEL
1. I have and will maintain a certificate of consent to self-insure for Worker's KITCHEN(3 00 SF);NEW AC UNIT;NEW TANK-LESS WATER
Compensation,as provided for by Section 3700 of the Labor Code,for the HEATER(RELOCATE TO OUTSIDE OF HOUSE);RELOCATED
performance of the work for which this permit is issued. WASHER&DRYER;REPLACE EXISTING WINDOWS(25)LIKE FOR
2. I have and will maintain Worker's Compensation Insurance,as provided for by LIKE TO MEET EGRESS
Section 3700 of the Labor Code,for the performance of the work for which this REV#2-RE-ROOF;TEAR-OFF;COMP SHINGLES(32 SQ)-ISSUED
permit is issued. 07/17/2019
APPLICANT CERTIFICATION REV#1 -STRUCTURAL CHANGES PER FIELD CONDITIONS-
I certify that I have read this application and state that the above 07/30/2018.
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 Sq.Ft Floor Area:527 Valuation:$127000.00
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. APN Number: Occupancy Type:
Additionally,the applicant understands and will comply with all non-point 362 25 046 R-3(Custom)
source regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date 07/15/2019 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: Issued by:Kim Dunbar
1. I,as owner of the property,or my employees with wages as their sole Date:06/18/2018
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 RE-ROOFS:
contractors to construct the project(Sec.7044,Business&Professions Code). 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
I hereby affirm under penalty of perjury one of the following three declarations: inspection.
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 Signature of Applicant:
performance of the work for which this permit is issued. Date:07/15/2019
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued.
exemption,I become subject to the Worker's Compensation provisions 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
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous
APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I
I certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
correct.I agree to comply with all city and county ordinances and state laws the Health&Safety Code,
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree Owner or authorized agent:
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:07/15/2019
judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY
consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.)
Code,Section 9.18. Lender's Name
Lender's Address
Signature Date 07/15/2019