B-2018-1343 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1343
21970 MCCLELLAN RD CUPERTINO,CA 95014-4058(356 08 032) VARGAS
CONSTRUCTION
BRENTWOOD,CA
94513
OWNER'S NAME: DATE ISSUED:09/26/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#589216
Contractor VARGAS CONSTRUCTION Date 02/29/2020 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:
CONSTRUCT ONE STORY ADDITIONS(615 SF);(N)ATTACHED
I hereby affirm under penalty of perjury one of the following two declarations: GARAGE(468 SF);PORCH CONVERSION/REMODEL INTO(N)
t. I have and will maintain a certificate of consent to self-insure for Worker's LIVING ROOM(324 SF);(N)FRONT COVERED PORCH(70 SF);
Compensation,as provided for by Section 3700 of the Labor Code,for the DEMOLISH(E)SHED(115 SF)AND SITE RETAINING WALL WITH
performance of the work for which this permit is issued. STEPS.
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:615 Valuation:$180000.00
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 356 08 032 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 9-26-2018 Issued by:Kim Dunbar
Date:09/26/2018
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. 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)
2. 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:9-26-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE 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 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
ernut is issu maintain compliance with the Cupertino Municipal Code,C ter 9.12 and the
a. certify t in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store o a dle hazardous
material. Additionally,should I use equipmeJ
hi h emit hazardous
all t employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area a ag en Di let I
er's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino ha 2 anemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Secti s n
abor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9-26-2018
I certify that I have read this application and state that the above information is CONSTRKTION LENDIN
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction len ' g agency 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 .)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep har ess the City of Cupertino against liabilities,
judgments,costs,and expen s hich may accrue against said City in Lender's Address
consequence of the granti f his permit. Additionally,the applicant understands
and will comply with all p ' t source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signatur 9-26-2018 Professional