B-2018-0763 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0763
20984 GARDEN GATE DR CUPERTINO,CA 95014-1810(326 30 014) ROYGBIV
CONSTRUCTION
120
OWNER'S NAME:DELA CRUZ ALLEN Y DAT /2018
OWNER'S PHONE:408-390-8883 PHONE NO:(408)838-2601
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Llc.#1028119
Contractor ROYGBIV CONSTRUCTION LLC Date 0613012019 X BLDG X 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 die Business&Professions Code and that my
license Is In full force and effect. JOB DESCRIPTION:
FIRST FLOOR ADDITION(624 SF),NEW ATTACHED GARAGE(485
1 hereby affirm under penalty of perjury one of the following two declarations: SF);REMODEL BATHROOM(1)(124 SF);REMODEL OTHER(775
1. I have and will maintain a certificate of consent to self-hnsme for Worker's SF);NEW ELECTRICAL PANEL(200 AMP);RELOCATED EXISTING
Compensation,as provided for by Section 3700 of the Labor Code,for the CONDENSER;(N)FURNACE;(N)WATER HEATER
performance of the work for which this permit is issued.
e. 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:624 Valuation:$155850.00
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 326 30 014 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
Addi lly,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 08!22118 Issued by:Haley McKee
- Date:08/22/2018
OWNER-BUILD UI DEF.'LAR
I hereby affirm that I aro 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. I,as owner of the property,or my employees with wages as thew sole installed without fast 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 Cade)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct One project(Sec.7044,Business&Professions Code), Date:08/22/18
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 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 25534.1 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 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 cerdfncate of will maintain compliance with the Cupertino Municipal Code,Chapter 9. and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod,.c,.Sections-25505^25$33,-and_25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. �``-.--
Owner orauthorized agent: C�
APPLICANT CERTIFICATION Date:08(272.18
I certify that I have read this application and state that the above Information Is CONSTRUE ION LENDING AGEN&
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that tiered a construe to.Jerrdlfi�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 ARCFDTECT'S DECLARATfory
Code,Section 9.1 B. I understand my plans shall be used as public records.
Signature Date 08/22/18 Licensed
Professional
I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0763
20984 GARDEN GATE DR CUPERTINO, CA 95014-1810 (326 30 014) ROYGBIV
CONSTRUCTION LLC
SAN JOSE, CA 95120
OWNER'S NAME: I I DATE ISSUED: 08/22/2018 1
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class .B Lic. #1028119
Contractor ROYGBIV CONSTRUCTION LLC Date 06/30/2019
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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
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.
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
and state laws relating to building construction, and hereby authorize
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations Section 9.18.
Signature Date 09/27/218
OWNE
I hereby affirm that I am pt from the Contractor's License Law for one of the
following two reasons:
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
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
PHONE NO: (
BUILDING PERMIT INFO:
X BLDG X ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
FIRST FLOOR ADDITION (624 SF), NEW ATTACHED GARAGE (485
SF); REMODEL BATHROOM (1) (124 SF); REMODEL OTHER (775
SF); NEW ELECTRICAL PANEL (200 AMP); RELOCATED EXISTING
CONDENSER; (N) FURNACE; (N) WATER HEATER
REV#2 - ROOF FRAMING AT GAR TO MATCH ARCH DRAWINGS -
ISSUED -09/27/2018
REV#1 - STRUCTURAL CHANGES - ISSUED 08/30/2018
Sq. Ft Floor Area: 624 1 Valuation: $155850.00
APN Number: Occupancy Type:
326 30 014 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Haley McKee
Date: 08/22/2018
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of Califomia. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 09/27/218
inspection.
Signature of Applicant:
Date: 09/27/218
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 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
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 255 3 -3 -,-an 5534.
Owner or authorized agent:
Date: 09/27/218 )
CONSTRUCTION
I hereby affirm that there is a construction ng agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:.
PERMIT NO: B-2018-0763
20984 GARDEN GATE DR CUPERTINO, CA 95014-1810 (326 30 014)
ROYGBIV
CONSTRUCTION LLC
SAN JOSE, CA 95120
OWNER'S NAME:
DATE ISSUED: 08/22/2018
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class -a Lic. #1028119
Contractor ROYGBIV CONSTRUCTION LLC Date 06/30/2019
X BLDG X 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:
FIRST FLOOR ADDITION (624 SF), NEW ATTACHED GARAGE (485
1 hereby affirm under penalty of perjury one of the following two declarations:
SF); REMODEL BATHROOM (1) (124 SF); REMODEL OTHER (775
r. I have and will maintain a certificate of consent to self -insure for Worker's
SF); NEW ELECTRICAL PANEL (200 AMP); RELOCATED EXISTING
Compensation, as provided for by Section 3700 of the Labor Code, for the
CONDENSER; (N) FURNACE; (N) WATER HEATER
performance of the work for which this permit is issued.
�[ z. 1 have and will maintain Worker's Compensation Insurance, as provided for by
REV#1 - STRUCTURAL CHANGES - ISSUED 08/30/2018
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area: 624
Valuation: $155850.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
326 30 014
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 this permit.
Additionally, the applicant understands and will comply with all ll non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino M iicipaLCode, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/30/2018
Issued by: Haley McKee
Date: 08/22/2018
OW R DEC
i
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. I, 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)
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: 08/30/2018
1 hereby affirm under penalty of perjury one of the following three declarations:
t. 1 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 for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
i. 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
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
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, 255534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 08/30/2018
I certify that I have read this application and state that the above information is
CO STRUETI"L
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction I g 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.
Signature Date 08/30/2018
Licensed
professional