B-2018-1067CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1067
7680 NORMANDY WAY CUPERTINO, CA 95014-5253 (366 17 053) BUILDCOM
CONSTRUCTION
SAN JOSE, CA 95111
OWNER'S NAME:
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #966238
Contractor BUILDCOM CONSTRUCTION Date 09/30/2019
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:
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.
2. 1t
will maintain Worker's Compensation Insurance, as provided for by
S cti n 700 of the Labor Code, for the performance of the work for which this
�i i 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 per theCupertinoMunicipal Code, Section 9.18.
Signature / �' Date 10/01/2018
MAW IJ -01 01 IJ 01WWO'.111KIN
DATE ISSUED: 10/01/2018
PHONE NO: (
BUILDING PERMIT INFO:
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(N) FRONT ADDITION (679 SF); (N) FRONT PORCH (65 SF); (N)
REAR PORCH (169 SF); REMODEL KITCHEN REMODEL (220 SF);
REMODEL BATHROOM (157 SF); REMODEL OTHER (992 SF); RE -
ROOF HOUSE (567 SF); UPGRADE ELEC PANEL (200 AMP); (N)
FURNACE; (N) TANKLESS WATER HEATER; FULLY SPRINKLER
HOUSE
Sq. Ft Floor Area: 679 I Valuation: $150000.00
APN Number: Occupancy Type:
366 17 1 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: Jasmine Archbold
Date: 10/0 1 /2018
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 stricture 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: 10/01/2018
I hereby affirm under penalty of perjury one of the following three declarations:
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.
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.
s. 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 10/01/2018
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 25505, 25533, and 25534.
Owner or authorized agent:
Date: 10/01/2018
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending 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
Profession
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1067
7680 NORMANDY WAY CUPERTINO,CA 95014-5253(366 17 053) BUILDCOM
CONSTRUCTION
SAN JOSE,CA 95111
OWNER'S NAME: DATE ISSUED:10/01/2018
OWNER'S PHONE:
DECLARATION BUILDING PERMIT INFO:
License Class la Lic.#966238
Contractor BUILDCOM CONSTRUCTION Date 09/30/2019 X BLDG X ELECT X 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:
(N)FRONT ADDITION(679 SF);(N)FRONT PORCH(65 SF);(N)
I hereby affirm under penalty of perjury one of the following two declarations: REAR PORCH(169 SF);REMODEL KITCHEN REMODEL(220 SF)
L I have and will maintain a certificate of consent to self-insure for Worker's REMODEL BATHROOM(157 SF);REMODEL OTHER(992 SF);RE-
Compensation,as provided for by Section 3700 of the Labor Code,for the ROOF HOUSE(567 SF);UPGRADE ELEC PANEL(200 AMP);(N)
Section 3700 of the Labor Code,for the performance of the work for which this REV#1-CHANGE OUT SINGLE SLIDING DOORS TO(2)SLIDING
permit is issued.
130-5117-FROM
FROM FAMILY ROOM TO DECK AREA-ISSUED 2-25-2019
APPLICANT CERTIFICATION Sq.Ft Floor Area:679 Valuation:$150000.00
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 APN Number: Occupancy Type:
representatives of this city to enter upon the above mentioned property for 366 17 053 R-3(Custom)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
source regulations the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 2-25-2019
Issued by:Jasmine Archbold
OWNER-BUILDER DECLARATION Date: 10/01/2018
I hereby affirm that I ant 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
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.
z. 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:2-25-2019
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 ALL ROOF COVERINGS TO BE CLASS A OR BETTER
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
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
the Health&Safety Code,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:2-25-2019
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction 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 2-25-2019
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1067
7680 NORMANDY WAY CUPERTINO,CA 95014-5253(366 17 053) BUILDCOM
CONSTRUCTION
SAN JOSE,CA 95111
OWNER'S NAME: DATE ISSUED: 10/01/2018
OWNER'S PHONE: PHONE NO:(408)605-9382
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#966238
Contractor BUILDCOM CONSTRUCTION Date 09/30/2019 X BLDG X ELECT X 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:
(N)FRONT ADDITION(679 SF); (N)FRONT PORCH(65 SF);(N)
I hereby affirm under penalty of perjury one of the following two declarations: REAR PORCH(169 SF);REMODEL KITCHEN REMODEL(220 SF);
have and will maintain a certificate of consent to self-insure for Worker's REMODEL BATHROOM(157 SF);REMODEL OTHER(992 SF);RE-
for Compensation,as provided by Section 3700 of the Labor Code,for the ROOF HOUSE(567 SF);UPGRADE ELEC PANEL(200 AMP);(N)
performance of the work for which this permit is issued. FURNACE;(N)TANKLESS WATER HEATER; FULLY SPRINKLER
2. I have and will maintain Worker's Compensation Insurance,as provided for by HOUSE
Section 3700 of the Labor Code,for the performance of the work for which this REV# I -CHANGE OUT SINGLE SLIDING DOORS TO(2) SLIDING
permit is issued. DOORS FROM FAMILY ROOM TO DECK AREA-ISSUED 2-25-2019
APPLICANT CERTIFICATION REV#2-CONVERT PATIO TO CONDITIONED SPACE-(169 SF)-
I certify that I have read this application and state that the above ISSUED 4/30/19
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:679 Valuation:$156000.00
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 66 Number: Occupancy Type:
3
may accrue against said City in consequence of the granting of this permit. 366 17 053 R-3(Custom)
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
- WITHIN 180 DAYS OF PERMIT ISSUANCE
Signature �
Date 4/30/19 C 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: Jasmine Archbold
following two reasons: Date: 10/01/2018
1. 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 RE-ROOFS:
sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is
2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for
contractors to construct the project(Sec.7044,Business&Professions Code). 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:4/30/19
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. HAZARDOUS MATERIALS DISCLOSURE
3. I certify that in the performance of the work for which this permit is issued,I I have read the hazardous materials requirements under Chapter 6.95 of the
shall not employ any person in any manner so as to become subject to the California Health&Safety Code,Sections 25505,25533,and 25534, I will
Worker's Compensation laws of California. If,after making this certificate of 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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
APPLICANT CERTIFICATION the Health&Safety Code,Sections 25505,25533,
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 Date:4/30/19 authorized agent:
30/19 �--
to enter upon the above mentioned property for inspection purposes. (We)agree CONSTRUCTION LENDING AGENCY
to save indemnify and keep harmless the City of Cupertino against liabilities,
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 4/30/19 ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1067
7680 NORMANDY WAY CUPERTINO,CA 95014-5253(366 17 053) BUILDCOM
CONSTRUCTION
SAN JOSE,CA 95111
OWNER'S NAME: DATE ISSUED: 10/01/2018
OWNER'S PHONE: PHONE NO:(408)605-9382
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#966238
Contractor BUILDCOM CONSTRUCTION Date 09/30/2019 X BLDG X ELECT X 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:
(N)FRONT ADDITION(679 SF);(N)FRONT PORCH(65 SF);(N)
I hereby affirm under penalty of perjury one of the following two declarations: REAR PORCH(169 SF);REMODEL KITCHEN REMODEL(220 SF);
i. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL BATHROOM(157 SF);REMODEL OTHER(992 SF);RE-
Compensation,as provided for by Section 3700 of the Labor Code,for the ROOF HOUSE(567 SF);UPGRADE ELEC PANEL(200 AMP);(N)
performance of the work for which this permit is issued. FURNACE;(N)TANKLESS WATER HEATER;FULLY SPRINKLER
have and will maintain Worker's Compensation Insurance,as provided for by HOUSE
., Section 3700 of the Labor Code,for the performance of the work for which this REV#1-CHANGE OUT SINGLE SLIDING DOORS TO 2 SLIDING
permit is issued. CORS FROM FAMILY ROOM TO DECK AREA-ISSUED 2-25-2019
APPLICANT CERTIFICATION Sq.Ft Floor Area:679 Valuation:$150000.00
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 17 053 R-3(Custom)
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 per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 2-25-2019
-` Issued by:Jasmine Archbold
OWNER-BUILDER DECLARATION Date: 10/01/2018
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
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:2-25-2019
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
perfonnance 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
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
the Health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION Owner or authorized agent:
D .. ._,-....
certify that I have read this application and state that the above information is 9
Date:2-25-2019
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction 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
understand my plans shall be used as public records.
Signature Date 2-25-2019
Licensed
Professional