B-2017-1080 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1080
10203 TONI CT CUPERTINO,CA 95014-2009(31623107)110201 TONT CT OWNER/BUILDER
CUPERTINO,CA 95014-2009(316 23 107)
OWNER'S NAME: DATE ISSUED:06/29/2018
OWNER'S PHONE: PHONE No:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor OWNER/BUILDER Dale X BLDG—ELECT—PLUMB
1 herebyaffirm that 1 am licensed under the provisions of Cha ter 9 —MECH X RESIDENTIAL_COMMERCIAL
a p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
licomse is fn fall force and effect. JOB DESCRIPTION:
(N)TWO STORY SFD(3515 SF);ATTACHED GAR(534 SF);PORCH
I hereby affirm under penalty of perjury one of the following two declarations: (71 SF);ATTACHED 2ND UNIT(365 S.F.)---LOT B
t. 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.
2. 1 have and will maintain Worker's Compensation huursoce,as provided for by
Section 3700 of the Labor Code,for the performance o£the wmk for which this
permit is issued. Sq.Ft Floor Area:4758 Valuation:$700000.00
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 316 23 113 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 Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06-29-2018 Issued by:Kim Dunbar
Date:06/29/2018
OWNER-BUILDER DECLARATION
I hereby aMr.,that I am exempt from the Conhmcto's License Law fmone of the RE-ROOTS:
following two reasons: All roofs shall be inspected prior to any rooting material being installed.If a roof is
t. 1,as owner o£the property,or my employees with wages as their sale installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
,lif 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:06-29-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO 13E CLASS"A"OR BETTER
t. 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 ofthe work for which this permit is issued. HAZARDOUS 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 Callfm nix Health&Safety Cade,Sections 25505,25533,and 25534.1 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 isissued,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 or devices which emft hazardous
afr contaminants as defined by the Bay 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 15
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revolted. Owner or authorized agent:
APPLICANT CERTIFICATION Date:06-29-2018
I certify that I have read this application and state that the above Information Is COM TRUC ON LENDI11 C,AGF, CY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a ccrpstruction lendkig 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-polo[source reguEfithCupertino Municipal ARCHITECT'S DECLARATIONCode,Section 9.18. 1 understand my plans shall be used as publicrecords.
Licensed
Signature 6-29-2018 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1.080
10203 TONI CT CUPERTINO, CA 95014-2009 (316 23 107) 10201 TONI CT OWNER/BUILDER
CUPERTINO, CA 95014-2009 (316 23 107)
OWNER'S NAME: DATE ISSUED: 06/29/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic. #
Contractor OWNER/BUILDER Date X 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 (3515 SF); ATTACHED GAR (534 SF); PORCH.
I hereby affirm under penalty of perjury one of the following two declarations: (71 SF); ATTACHED 2ND UNIT (365 S.F.)--- LOT B
1. I have and will maintain a certificate of consent to self-insure for Worker's REV # 1 - REVISE TITLE 24 - ISSUED 8.18. 18
Compensation, as provided for by Section 3700 of the Labor Code, for the
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
permit is issued. Sq. Ft Floor Area: 4758 Valuation: $700000.00
APPLICANT CERTI.FICATION
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 Number: Occupancy Type:
316
and state laws relating to building construction, and hereby authorize 31.6 23 11.3 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 184 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 10.18.18 Issued by: Sean Hatch
Date: 06/29/2018
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
1. 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
compensation, will do the work, and the structure is not intended or offered for inspection.
sale (Sec.7044, Business & Professions Code)
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
performance of the work for which this permit is issued. HAZARDOUS 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
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
air contaminants as defined by the Bay 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, 2 533 . and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. /
Owner or authorized agent:
.APPLICANT CERTIFICATION Date: 10.18.18
certify that I have read this application and state that the above information is CONS F UCTION UNDING 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 works 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.
Signature -Date 10.18.18 Licensed
Professional