B-2018-1542 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1542
1188 CRESTLINE DR CUPERTINO,CA 95014-5035(362 24 038) NEWHOME
CONSTRUCTION
CORPORATION
FREMONT,CA 94539
OWNER'S NAME: DATE ISSUED:05/01/2019
OWNER'S PHONE: PHONE NO:(408)421-9808
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#832709
Contractor NEWHOME CONSTRUCTION CORPORATION Date 11/30/2020 X BLDG X 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:
ONE STORY ADDITION(333 SF);FRONT COVERED PORCH(20 SF);
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL KITCHEN(144 SF);REMODEL BATHROOM(20 SF);
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL OTHER(322 SF);RAISE ROOF IN GARAGE(305 SF);
p � p y � REPLACE(2)WINDOWS IN FAMILY RM;RELOCATE FURNACE TO
performance of the work for which this permit is issued. GARAGE;UPGRADE ELECTRICAL PANEL(200 AMP);RE-ROOF
2. I have and will maintain Worker's Compensation Insurance,as provided for by HOUSE AND GARAGE(25 SQ).
Section 3700 of the Labor Code,for the performance of the work for which this REV#1 -REVISE INTERIOR LAYOUT AT BEDROOM#3 AND
permit is issued. BATHROOMS;REMOVE(E)WALL AT KITCHEN AND INSTALL
APPLICANT CERTIFICATION BEAM WITH FOOTING-ISSUED 06/03/2019
1 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 Sq.Ft Floor Area:333 Valuation:$120000.00
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 APN Number: Occupancy Type:
may accrue against said City in consequence of the granting of this permit. 362 24 038 R-3(Custom)
Additionally,the applicant understands and will comply with all non-point
source
06/03/2019 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by:Kim Dunbar
following two reasons: Date:05/01/2019
1. I,as owner of the property,or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) RE-ROOFS:
2. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is
contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicant:
Compensation,as provided for by Section 3700 of the Labor Code,for the Date:06/03/2019
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If'after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will
maintain compliance with the Cupertino Municipal Code Chapter 9.12 and the
exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Section 25532(a)should I store or handle hazardous
Labor Code,I must forthwith comply with such provisions or this permit shall material. Additionally,should I use equipment or devices which emit hazardous
be deemed revoked. air contaminants as defined by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25-505,25533,.,and 25534.
1 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 Owner or authorized agent:
to enter upon the above mentioned property for inspection purposes. (We)agree Date:06/03/2019 -
judgments,costs,and expenses which may accrue against said City in I hereby affirm that there is a construction lending agency for the performance
consequence of the granting of this permit. Additionally,the applicant understands of work's for which this permit is issued(Sec.3097,Civ C.)
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Name
Code,Section 9.18.
Lender's Address
Signature Date 06/03/2019 ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1542-
1188
-2018-15421188 CRESTLINE DR CUPERTINO,CA 95014-5035(362 24 038) OWNER BUILDER
OWNER'S NAME: DATE ISSUED:05/01/2019
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor OWNER BUILDER Date X BLDG X 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:
ONE STORY ADDITION(333 SF);FRONT COVERED PORCH(20 SF);
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL KITCHEN(144 SF);REMODEL BATHROOM(20 SF);
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL OTHER(322 SF);RAISE ROOF IN GARAGE(305 SF);
Compensation,as provided for by Section 3700 of the Labor Code,for the REPLACE(2)WINDOWS IN FAMILY RM;RELOCATE FURNACE TO
performance of the work for which this permit is issued. GARAGE;UPGRADE ELECTRICAL PANEL(200 AMP);RE-ROOF
2. I have and will maintain Worker's Compensation Insurance,as provided for by HOUSE AND GARAGE(25 SQ).
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area:333 Valuation:$120000.00
1 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 24 038 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
may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5-1-5019
Issued by: Kim Dunbar
OWNER-BUILDER DECLARATION Date: 05/01/2019
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
1. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
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,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant:
Date:5-1-5019
I hereby affirm under penalty of perjury one of the following three declarations:
1. I 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.
2. I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
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. 1 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
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Cod ,Sections 25505,25533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION Owner or authorized agent:
`
I certify that I have read this application and state that the above information is Date: 5-1-5019CONSTRUCTION LENDING 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
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
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
Date 5-1-5019 Licensed
Professional