B-2017-1643 CITY OF CUPERTINO BUILDING PERMIT
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BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1643
1575 JAMESTOWN DR CUPERTINO,CA 95014-5312(366 10 095)• TALENT DECIDE INC
LOS GATOS,CA 95030
OWNER'S NAME: DATE ISSUED: 11/28/2017
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTORS DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#808951
Contractor TALENT DECIDE INC Date 06/30/2018 X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
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. JOB DESCRIPTION:
1ST FLOOR ADDITION(159 SF);KITCHEN REMODEL(140 SF);
I hereby affirm under penalty of perjury one of the following two declarations: CLOSETS REMODEL(90 SF);(3)BATHROOMS REMODEL(128 SF);
1. I have and will maintain a certificate of consent to self-insure for Worker's (N)2ND FLOOR BATHROOM#3(41 SF);(N)SLIDER DOOR;(N)BAY
Compensation,as provided for by Section 3700 of the Labor Code,for the WINDOW;(N)3 WINDOWS;(N)TANK-LESS WATER HEATER;RE-
, per°mance of the work for which this permit is issued. ROOF ENTIRE HOUSE(2,000 SF)
' 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: Valuation:$85000.00
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 366 10 095
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.
'° ature Date 11/28/2017 Issued by:Abby Ayende
Date:11/28/2017
OWNER-BUILDER DECL TION
I hereby affirm that I am exempt from the Contractor's License Law fortune of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofmg 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:11/28/2017
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. 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
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of 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 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall /
be deemed revoked. 04t -r or authorized agent:
APPLICANT CERTIFICATION 41 '-te:11/28/2017
I certify that I have read this application and state that the above information is CONSTRU - ON LE 'INC 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. I understand my plans shall be used as public records.
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Licensed
Signature Date 11/28/2017 Professional
CITY OF CUPERTINO BUILDINGG PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1643
1575 JAMESTOWN DR CUPERTINO, CA 95014-5312 (366 10 095) - TALENT DECIDE INC
LOS GATOS, CA 95030
OWNER'S NAME: DATE ISSUED: 11/28/2017
OWNER'S PHONE: PHONE NO, (408) 306-3968
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. X808951 XBLDG ELECT X PLUMB
Contractor TALENT DECIDE INC Date 06/30/2020 — — —
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:
1ST FLOOR ADDITION (l 59 SF); KITCHEN REMODEL (140 SF);
I hereby affirm under penalty of perjury one of the following two declarations: CLOSETS REMODEL (90 SF); (3) BATHROOMS REMODEL (128 SF);
1, I have and will maintain a certificate of consent to self-insure for Worker's (N) 2ND FLOOR BATHROOM #3 (41 SF); (N) SLIDER DOOR; .(N) BAY
Compensation, as provided for by Section 3700 of the Labor Code, for the WINDOW; (N) 3 WINDOWS; (N) TANK-LESS WATER HEATER; RE-
performance of the work for which this permit is issued. ROOF ENTIRE HOUSE (2,000 SF)
I have and will maintain Worker's Compensation Insurance, as provided for by REV#1 - RECONFIGURE BATHROOM - ISSUED 6-18-2018
Section 3700 of the Labor Code, for the performance of the work for which this REV#2 - REPLACE FURNACE (SAME LOCATION)-ISSUED 10-12-
permit is issued. 2018
APPLICANT CERTI.FICATION Sq. Ft Floor Area: Valuation: $85000.00
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
and state laws relating to building construction, and hereby authorize APN Number: Occupancy Type:
representatives of this city to enter upon the above mentioned property for 366 10 095
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
source regulations Code, Section 9. 18: WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 10-12-2018
Issued by: Abbbbyey nde
OWNER-BUILDER DECLARATION Date: 11/28/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
1. 1; 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
compensation, will do the work,and the structure is not intended or offered for installed without first obtaining an inspection, I agree to remove all new materials for
sale (Sec.7044, Business & Professions Code) inspection.
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec,7044, Business & Professions Code). Signature of.Applicant:
I hereby affirm under penalty of perjury one of the following three declarations: Date: 10-12-2018
1. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
performance of the work for which this permit is issued.
2. 1 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
permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will
3. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous
Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should .I use equipment or devices which emit hazardous
exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I
:Labor Code' I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
be deemed revolted, the Health & Safety Code, Sections 25505, 25533, and 25534.
APPLICANT CERTIFICATION � -
Owner or authorized agent:
I certify that I have read this application and state that the above information is Date: 10-12-2018
correct. I agree to comply with all city and county ordinances and state laws
CONSTRUCTION LEX6ING AGENCY
relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a constructia lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We) agree
of work's for which this permit is issued (Sec. 3097, Civ C.)
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
consequence of the granting of this permit. Additionally, the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code, Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 10-12-2018
Licensed
Professional