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B-2018-0590 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0590 10711 FARALLONE DR CUPERTINO,CA 95014-4409(369 35 014) NORDIN BUILDERS INC SAN JOSE,CA 95112 OWNER'S NAME: DATE ISSUED:06/27/2018 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#949409 Contractor NORDIN BUILDERS INC Date 06/3012020 X BLDG X 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 farce and effect. JOB DESCRIPTION: CONSTRUCT ONE STORY ADDITIONS(379 SF);INTERIOR I hereby affirm under penalty of perjury one of the following two declm ations: REMODEL OF(E)SFD(1780 SF);GARAGE CONVERSION INTO t. I have and will maintain a certificate of consent to self-mane for Worker's HABITABLE SPACE(28 SF);(N)COVERED PORCH(27 SF);(N) Compensation,as provided for by Section 3700 of the Lahm Code,for the COVERED TERRACE(205 SF);(N)WATER HEATER;(N)FURNACE peribrre cc of the work for which this permit is issued, AND A/C;DEMOLISH ATTACHED ENCLOSED PATIO(150 SF); I have and will maintain Worker's Compensation Insurance,as provided for by DEMOLISH IN-GROUND SWIMMING POOL(450 SF) Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area:379 Valuation:$350000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all ally and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 35 014 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 Cade,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Sig Date:06/27/2018 OWNER-BUILDER DECLARATION T hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All of,shall be inspected prior to arty roofing material being installed,f£a roof is a I,as owner of the property,m my employees with wages as their sale installed without first obtaining an inspection,I agree to remove all now 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:06-27-2018 I hereby aIfirm under penalty of perjury one of the following three deal—times: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. I have and will maintain a Certificate of Coreart to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the Parfet mance 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 umterials 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 s. i certify that in the performance of the work far which this permit is issued,I Health&Safety Code,Section 25532(a)should t 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 endt hazardous air am continants as defined by the Buy 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 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized 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. SignatureLicensed Date 06-27-2018 Professional