B-2018-1307 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1307
21451 ELM CT CUPERTINO,CA 95014-4919(362 01 019) COMPLETE
CONSTRUCTION
EXPERTS INC
SAN JOSE,CA 95129
OWNER'S NAME: DATE ISSUED:08/02/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.lf100932
Contractor COMPLETE CONSTRUCTION EXPERTS INC Dale 12/31/2019 X BLDG ELECT X PLUMB
1 hereby affirm that I nm licensed underthe provisions of Chapter 9(commencing MECII 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:
REMODEL KITCHEN-(150 SF);REMODEL MASTER BATH-(61
I hereby affirm under penalty of perjury ono of the following has declarations: SF);REMODEL FAMILY BOOM(250 SF);(N)CLEANOUT
I 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
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 Fluor Area: Valuation:$55000.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate 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 36201 019
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,th app ppant understands and will comply with all non-point
source regula ons psi the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 0810 212 01 8 Issued by:Jasmine Archbold
Date:08/02/2018
OWNER-
I hereby affirm that I am exempt from the Contractor's License Law I'or one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed,If e roof is
a. I,as owner of the property,or my employees with wages as their sole installed without first obtaining all 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)
x. I,as owner ofthe property,am exclusively contracting with licensed Signature afApplicant
contractors to cont Let the project(Sec.7044,Business&Professions Code), Date,08/02/2018
I hereby affirm under piously.]'perjury ane of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 have and will maintain a Certificate of Consent to selpinsure for Worker's
Compensation,as provided for by Section 3700 of die Labor Codd,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous late,lots requirements under Chapter 6.95.1[he
Section 3700 of the Labor Code,for the performance of 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 per armaned of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should 1 store dr handle hazardous
shall not employ any person in any manner so as to herniae subject to the naterinh Additionally,should I use equipment or devices which call hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws cf Califiendo.If,after making this certificate of will maintain compliance with the as-E
Municipal Code,Chaplet,9.12 and
exemption,I become subject to the Worker's Compensation previsions of the the Health&Safety Code25505,25533,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:08/02/2018
I certify that I have read this application and state that the above Information Ia CONSTRUCTION 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 08/02/2018 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1307
21451 ELM CT CUPERTINO,CA 95014-4919(362 01 019) COMPLETE
CONSTRUCTION
EXPERTS INC
SAN JOSE,CA 95129
OWNER'S NAME: DATE ISSUED:08/02/2018
OWNER'S PHONE: PRONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INEO',
License Class B Lic.41009320
Contractor COMPLETE CONSTRUCTION EXPERTS INC Dale 12/31/2019 X BLDG_ELECT X PLUMB
I hereby affirm that I am licensed render the provisions of Chnptm•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:
REMODEL KITCHEN-(150 SF);REMODEL MASTER BATH-(61
I hereby affirm under penalty of perjury one of the following two declarations: SF);REMODEL FAMILY ROOM(250 SF);(N)CLEANOUT
1. 1 have and will maintain a certificate of consent to self-insure for Worker's
\
have and will maintain Worker's Compensation Insurance,as provided far by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.IT Floor Area: Valuation:$55000,00
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 362 01 019
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 1$0 DAYS OF PERMIT ISSUANCE OR
Additionally,the applica t understands and will comply with all non-point
source regulations pe e Cupertino Munlci I.Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/15/2018 Issued by:Jasmine Archbald
Date:08/02/2018
OWNFR-Iil ,DER D LARATION
1 hereby affirm that I am exempt from the Contractor's License Law]or one O the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.its roof is
1. I,as owner of the property,army 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)
2. I,as owner of Nle property,am exclusively contracting with licensed Signature of Applicant;
contractors to construct the project(See.7044,Business&Professions Code). Date:08/15/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO RE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to selfiinsurc 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
x. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for t11e performance of 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 Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,l 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 l use equipment or devices which emit hazardous
air contaminants as defined by the
Q Area Air Quality Management District I
Worker's Compensation laws of California,If,after making this certificate of will maintain compliance with the C pectins Mnhlicipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety Cod Sections 25505v,25533,and 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall
be dccmod revoked. - Owner or authorized eget,'
APPLICANT CERTIFICATION Date:08/16/2018
1 certify that I have read this application and state that the above information is CONSTRUCTION LENUINC 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 ARCA I'1'EC'I"5 DECLARATION
Code,Section 9.18. 1 understand my plans shell be used as public records.
Signature Date 08/15/2018 Licensed
Professional