B-2018-0876 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR PERMITNO;13-2018-0876
49866 BAYWOOD DR CUPERTINO,CA 95014-2317(316 30 011) P N CUSTOM
BUILDER
M[LPITAS,CA 95035
OWNER'S NAME: UNIT ISSUEDt 08/0312018
OWNER'S PHONEt PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class l2 Lic,4951110 X BLDG_ELECT_PLUMB
Contractor P N CUSTOM BUILDER Dale 08131/2018
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing x MECH$RESIDENTIAL_COMMERCIAL
with$coffee 7000)of Division 3 of the Business&Professions Cade and that my
license Is In full force and effect. JOB DESCRIPTION:
KITCHEN REMODEL(t 50 S.F.);BATHROOM REMODEL(100 S.F.);
I herehy affirm under penalty of perjury one of the following two declarations: (N)HVAC SYSTEM;PANEL UPGRADE(200 AMPS);CONVERT(2)
L I have and will maintain a certificate of consom to self-insure for Worker's BEDROOMS INTO MASTER BEDROOM AND ADD KITCHEN TO
Compensation,as provided for by Section 3700 of the Labor Code,for the MASTER BEDROOM(432 S.F.);CONVERT GARAGE TO
performance of rhe work for which this permit is issued, CONDITIONAL SPACE(24 SA);REWIRE ENTIRE HOUSE
' -(
Section 37DO of the Labor Code,for the performance of the work for which this
permit is Issued, Sq.Ft Flma•Area!24 Valuatin a$100000.00
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: Oceup[ulcy Type:
and state laws relating to building construction,and hereby authorize 3163D 011 k-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 STAR'T'ED
may accrue against sold City In consequence of the granting of this permll, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source,regulations the FTON
pal Code,Sectlon 9,18. 180 DAYS FROM LAST CALLED INSPECTION,
Signature Date 08 3 Issued by:Kim Dunbar .
Date: 12018
nWNFIt-nrH1 D DECI
I hereby a£Rrm that I am exempt from the Centimeter's License Low for one of the RR ROOFS•
following two reasons: All roup shall be inspected prior to any roofing material being installed.If a roar is
1. 1,as owner of the property,or my employees with wages as theh sole Installed without first obtaining an inspection,I agree to remove all new materials fbr
cmnpensallon,will do the work,and the sh'uct ce is act 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(Seo,7044,Business&Professions Code). Dale;08/03/19
I heroby affirm trader penalty or PerJ m'y one of the following three doclaaflons' ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
a, 1 have and will maiutaih n Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance of tiro work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
a. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have rent]the hnzordous materials requirements under Chapter 6,95 of the
Section 3700 of the Labor Code,For file performance of the work for which this California Health&Safety Code,Sections 25505,25533,slid 25534.twill
permit is issued. traf vuln compliance with the Cupertino Municipal Code,Chapter 9.12 and the
e
a. the performance oFthe work far which this permit is issued,[ Healthm•&Safety Code,Section 25532(n)should I Arne handle Ianr
zdons
I certify that in
shelf not employ any person in any manner se os to become subject to the airmutcontal.minants
ina tis as de,i should b I ileo ay Are A or Qualitdevicey
snaghich emit hazardous
nh�cattnminanta ns defined by the Bay Area Air Qunllty Mnnngemeut District I
Worker's Compensation laws of California.If,after making this certificate of will maintain eomplianca with the Cupertino Municlpnl Code,Chapter 9.12 mrd
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 255 and 25534.
Labor Code,l must forthwith oomplywith such provisions or this permit shaft
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIRICAIM Data:0=3118
I certify that I have read this application and state that the above information Is CCO ,5-' i -TI E Y
correct.I agree to comply w th 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 herehy authorize representatives of this city of work's for which this permit is Issued(Seo,3097,Clv 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 Cuporllno 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-polni source regulations per the Cupertino Municipal AR('}I[TECT'S DF,CI ARA'ITON
Code,Section 9.18. 1 understand my plans shall be used as publlc records,
Licensed
Signature Date DH703118 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0876
19866 BAYWOOD DR CUPERTINO,CA 95014-2317(316 30 011) P N CUSTOM
BUILDER
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:08/03/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#951110
Contractor P N CUSTOM BUILDER Date 08/31/2018 X BLDG —ELECT —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:
KITCHEN REMODEL(150 S.F.);BATHROOM REMODEL(100 S.F.);
I hereby,kffirm under penalty of perjury one of the following two declarations: (N)HVAC SYSTEM;PANEL UPGRADE(200 AMPS);CONVERT(2)
have and will maintain Worker's Compensation Insurance,as provided for by PORCH-(66 SF)-ISSUED 9/13/18
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:130 Valuation:$100000.00
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 30 011 R-3(Custom),R-3(Custom),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 Cu ino M icipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signa Date 18 Issued by:Kim Dunbar
Date:08/03/2018
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
m. I,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. 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:09/13/18
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
m. 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
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
3. 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 2550.Y553 and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. L�
Owner or authorize gen
APPLICANT CERTIFICATION Date:09/13/18
I certify that I have read this application and state that the above information is ONSTRUCTIO ENCY
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.
Licensed
Signature Date 09/13/18
Professional