B-2016-2219 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2219
7804 ROBINDELL WAY CUPERTINO, CA 95014-5015 (362 23 00 1) ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'S NAME: DATE ISSUED: 01/20/2017
OWNER'S PHONE: PHONE NO: (408) 441-0967
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #909433
ContractorALI'S CONSTRUCTION & REMODELING INC Date 01/31/2020 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:
ADD (778 S.F.) TO FRONT AND REAR; REMODEL (922 S.F.); RE-
I hereby affirm under penalty of perjury one of the following two declarations: ROOF; TEAR OFF; INSTALL COMP SHINGLES (12 SQS); UPGRADE
1. I have and will maintain a certificate of consent to self-insure for Worker's ELECTRICAL PANEL TO (200 AMPS); INSTALL (N) A/C; REPLACE
Compensation, as provided for by Section 3700 of the Labor Code, for the FURNACE
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided'for by REV#1 - LEAVE EXISTING SLAB - ISSUED 4-20-2017- ISSUED 12-4-
Section 3700 of the Labor Code, for the performance of the work for which this 2018
permit is issued. REV#2 - RELOCATE TANKLESS WATER HEATER TO GARAGE
APPLICANT CERTIFICATION EXTERIOR WALL -
certify that I have read this application and state that the above Sq. Ft Floor Area: 778 Valuation: $150000.00
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
representatives of this city t nter upon the above.mentioned property for APN Number: Occupancy Type: .
inspection purposes. (W°e) agreb, to save indemnify and keep harmless the 362 23 001 Deferred Submittal (R-3),R-3 (Custom)
City of Cupertino agail6t Iia i-1` ,,:; Judgments, costs, and expenses which
may accrue againsisaid Ciink con$equence of the granting of this permit.
Additionally, the applicant ndel,'rstarides and will comply with all non-point
source regulations per th,- ,Cu-erti,rl,pejMunicipal Code, Section 9. 18. PERMIT EXPIRES IF WORK IS NOT STARTED
�
�"�'
Signature Dat 12-4-2018 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION, Issued by: Abby AVende
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 01/20/2017
following two reasons:
1. 1, 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 inspection.
contractors to construct the project (Sec,7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Date: 12-4-2018
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is.issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
3. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Worker's Compensation laws of California, If, after making this certificate of Health &.Safety Code, Section 25532(a) should I store or handle hazardous
exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipme .>t" devices which emit hazardous
Labor Code I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Ar_Ai u lity Management District I
p y p p will maintain compliance with the Cupert no u i al Code, Chapter 9.12 and
be deemed revoked, .�-,...,,..y ��:a..u.,, , t
the Health & SafetX.,fade;°SeG ions 550 2553 ';` °nc 25534.
APPLICANT CERTIFICATION 0'*0000 - :)
1 certify that I have read this application and state that the above information is Owner or authorized <ag.1. -
correct. I agree to comply with all city and county ordinances and state laws Date: 12-4-2018
relating to building construction, and hereby authorize representatives of this city
CONSTRLJCTION LEND,14AGENCY
to enter upon the above mentioned property for inspection purposes. (We) agree I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.)
judgments, costs, and expenses which may accrue against said City in Lender's Name
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code, Section 9.18.
ARCHITECT'S DECLARATION
Signature Date 12-4-2018 1 understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
7804 ROBINDELL WAY CUPERTINO, CA 95014-5015 (362 23 001)
CONTRACTOR:
ALPS CONSTRUCTION
PERMIT NO: B-2016-2219
& REMODELING INC
{
SAN JOSE, CA 95129
;
OWNER'S NAME:
DATE ISSUED: 01/20/2017
OWNER'S PHONE:
PHONE NO: (408)441-0967
LICENSED N ONTRA TOR' DECLARATION
BUILDING PERMIT INFO: �
License Class B Lic. #909433
Contractor ALI'S CONSTRUCTION & REMODELING INCDate 01[31/2018
X BLDG X ELECT _ PLUMB i
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:
I hereby affirm under penalty of perjury one of the following two declarations:
ADD (778 S.F.) TO FRONT AND REAR; REMODEL (922 S.F.); RE-
ROOF; TEAR OFF; INSTALL COMP SHINGLES (12 SQS)• UPGRADE
1. I have and will maintain a certificate of consent to self -insure for Worker's
ELECTRICAL PANEL TO (200 AMPS); INSTALL (I) A/C; REPLACE
Compensation, as provided for by Section 3700 of the Labor Code, for the
FURNACE
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
REV41 LEAVE EXISTING SLAB - ISSUED 4-20-2017
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area: 778
Valuation: $150000.00
APPLICANT CERTIFICATION
1 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
362 23 001
Deferred Submittal (R -3),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 i
may accrue against said City in consequence the granting this permit.
Additionally, the applicant understands and willl comply it all ll non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR I
source regulations per the Cupertino Municipal Cod ction 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signat
OWNER -BUILDER DECLARATION
Date: 01/20/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE -ROOFS: –�—I
All ioofs shall be inspected prior to any roofing material being installed. If a roof is j
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 fb;
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: 04-20-2017
I hereby affirm under penalty of perjury one of the following three declarations:
i. 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.
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,
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, 25533, and 255 3,4. _
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent % j
APPLICANT CERTIFICATION
Date: 04-20-2017
TION
I certify that I have read this application and state that the above information is
CONST CU 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
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 04-20-2017
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2219
7804 ROBINDELL WAY CUPERTINO, CA 95014-5015 (362 23 001) ALPS CONSTRUCTION i
& REMODELING INC
SAN JOSE, CA 95129 ;
OWNER'S NAME:
OWNER'S PHONE:
License Class is Lic. #902433
Contractor ALPS CONSTRUCTION & REMODELING INC Date 01/31/2018
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. 1 have and will maintain a certificate of consent to self -insure for Worker's
C9mpensation, 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
permit is issued.
AFPLIC NT 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.
AdditionallT,,-��Date
Iiant understands and will comply with all npn-point
source regthe Cupertino Municipal Code, Section 9.18.
S1anature 1/20/2017
I hereby affirm that
following two reasor
1, 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)
1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
from the Contractor's License Law for one of the
hereby affirm under penalty of perjury one of the following three declarations,
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
performance of the work for which this permit is issued.
z. 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.
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 California. 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 1/2012017
ISSUED: 01/20/2017
NO: (408) 441-0967
F9W%tL��
X BLDG X ELECT —PLUMB
X MECH X RESIDENTIALI COMMERCIAL
i
JOB DESCRIPTION: 9
ADD (778 S.F.) TO FRONT" AND REAR; REMODEL (922 S.F.); RE -
ROOF; TEAR OFF; INSTALL] COMP SHINGLES (12 SQS); UPGRADE
ELECTRICAL PANEL TO (20,0 AMPS); INSTALL (N) A/C; REPLACE
FURNACE i
Sq. Ft Floor Area: 778 ]Valuation: $150000.00
"N Number: Occupancy Type:
362 23 001 Deferred Submittal (R -3),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: Abby A, endg
Date: 01/20/2017
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an jnspection, I agree to remove all new materials for
! inspection.
Signature ofApplicant:
Date:.1/2¢017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 695 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, Secdon�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, SectipnsA5505, 25533, and 25534.
Owner or authorized agent:
Date. 1/20/2017
CONSTRUC'T'ION Ente
Vinn
I hereby affirm that there is a constructgency for the performance
of work's for which this permit is jssued, CivC.)
Lender's Name
Lender's Address
ARCH1T�CT'_S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional