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B-2019-0400 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0400 10530 PINEVILLE AVE CUPERTINO,CA 95014-4529(369 13 029) AAA CONSTRUCTION CUPERTINO,CA 95014 OWNER'S NAME: DATE ISSUED:03/29/2019 OWNER'S PHONE: PHONE NO:(408)728-3854 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#1038374 Contractor AAA CONSTRUCTION Date 04/30/2020 X BLDG x ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL witli Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: KITCHEN REMODEL(250 SF),REMOVE WALL;REMODEL FAMILY I hereby affirm under penalty of perjury one of the following two declarations: ROOM(285 SF);SECOND FLOOR-CONVERT BEDROOM AREA 1. I have and will maintain a certificate of consent to self-insure for Worker's INTO BATHROOM(40 SF);RELOCATE(1)WINDOW;UPGRADE Compensation,as provided for by Section 3700 of the Labor Code,for the ELECTRICAL IN BEDROOM(5)LIGHTS AND(9)OUTLETS;FIRST performance of the work for which this permit is issued. FLOOR(2)NEW WINDOWS,RESIZE(1)WINDOW, SECOND FLOOR I have and will maintain Worker's Compensation Insurance,as provided for by (2)NEW WINDOWS,BEDROOM RELOCATE(1)WINDOW,REMOVE Section 3700 of the Labor Code,for the performance of the work for which this FIRE PLACE permit is issued. _ REV#2 NEW SUB-PANEL(100 AMP)GARAGE ISSUED 05/06/2019 APPLICANT CERTIFICATION REV#1 -CHANGE SHEAR WALL DIMENSION-ISSUED 4/17/19 1 certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$70000.00 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 to enter upon the above mentioned property for APN Number: Occupancy Type: inspection purposes. (We)agree to save indemnify and keep harmless the 369 13 029 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 Date 05/06/2019 180 DAYS FROM LAST CALLED INSPECTION, OWNER-BUILDER DECLARATION Issued by:Haley McKee I hereby affirm that I am exempt from the Contractor's License Law for one of the Date:03/29/2019 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. I have and will maintain a Certificate of Consent to self-insure for Worker's Date:05/06/2019 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 HAZARDOUS MATERIALS DISCLOSURE permit is issued. 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 equipment or devices which emit hazardous Labor Code,I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and 25534. APPLICANT CERTIFICATION �. certify that I have read this application and state that the above information is au Owner or authorized correct.I agree to comply with all city and county ordinances and state laws Date:Dor au 019 relating to building construction,and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY 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 05/06/2019 1 understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0400 10530 PINEVILLE AVE CUPERTINO,CA 95014-4529(369 13 029) AAA CONSTRUCTION CUPERTINO,CA 95014 OWNER'S NAME: DATE ISSUED:03/29/2019 OWNER'S PHONE: PHONE NO:(408)728-3854 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#1038374 Contractor AAA CONSTRUCTION Date 04/30/2020 X BLDG X 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: KITCHEN REMODEL(250 SF),REMOVE WALL;REMODEL FAMILY I hereby affirm under penalty of perjury one of the following two declarations: ROOM(285 SF);SECOND FLOOR-CONVERT BEDROOM AREA 1. I have and will maintain a certificate of consent to self-insure for Worker's INTO BATHROOM(40 SF);RELOCATE(1)WINDOW;UPGRADE Compensation,as provided for by Section 3700 of the Labor Code,for the ELECTRICAL IN BEDROOM(5)LIGHTS AND(9)OUTLETS;FIRST ,. performance of the work for which this permit is issued. FLOOR(2)NEW WINDOWS,RESIZE(1)WINDOW, SECOND FLOOR I have and will maintain Worker's Compensation Insurance,as provided for by (2)NEW WINDOWS,BEDROOM RELOCATE(1)WINDOW,REMOVE Section 3700 of the Labor Code,for the performance of the work for which this FIRE PLACE permit is issued. REV#3-RE-ROOF;TEAR-OFF;INSTALL 1/2"OSB;INSTALL APPLICANT CERTIFICATION ASPHALT SHINGLES-(30 SQ)-ISSUED 05/09/2019 - certify that I have read this application and state that the above REV#2 NEW SUB-PANEL(100 AMP)GARAGE-ISSUED 0.5/06/2019 information is correct.I agree to comply with all city and county ordinances REV#1 -CHANGE SHEAR WALL DIMENSION-ISSUED 4/17/19 and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for Sq.Ft Floor Area: Valuation:$82000.00 inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which APN may accrue against said City in consequence of the granting of this permit. Number: Occupancy Type: 369 Additionally,the applicant understands and will comply with all non-point 369 13 029 source regulations per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature �`� Date 05/09/2019 - WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by:Haley McKee 1. I,as owner of the property,or my employees with wages as their sole Date:03/29/201.9 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 I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date:05/09/2019 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous be deemed revoked. material. Additionally,should I.use equipment or devices which emit hazardous 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 certify that I have read this application and state that the above information is the Health&Safety 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 Owner�r authorized agent: Date:05/09/2019 to save indemnify and keep harmless the City of Cupertino against liabilities, � judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.) Code,Section 9.18. Lender's Name Lender's Address Signature Date 05/09/2019 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0400 10530 PINEVILLE AVE CUPERTINO,CA 95014-4529(369 13 029) AAA CONSTRUCTION CUPERTINO,CA 95014 OWNER'S NAME: DATE ISSUED:03/29/2019 OWNER'S PHONE: PHONE NO:(408)728-3854 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#1038374 Contractor AAA CONSTRUCTION Date 04/30/2020 X BLDG X 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: KITCHEN REMODEL(250 SF),REMOVE WALL;REMODEL FAMILY I hereby affirm under penalty of perjury one of the following two declarations: ROOM(285 SF); SECOND FLOOR-CONVERT BEDROOM AREA 1. I have and will maintain a certificate of consent to self-insure for Worker's INTO BATHROOM(40 SF);RELOCATE(1)WINDOW;UPGRADE Compensation,as provided for by Section 3700 of the Labor Code,for the ELECTRICAL IN BEDROOM(5)LIGHTS AND(9)OUTLETS;FIRST performance of the work for which this permit is issued. FLOOR(2)NEW WINDOWS,RESIZE(1)WINDOW, SECOND FLOOR I have and will maintain Worker's Compensation Insurance,as provided for by (2)NEW WINDOWS,BEDROOM RELOCATE(1)WINDOW,REMOVE Section 3700 of the Labor Code,for the perfonnance of the work for which this FIRE PLACE permit is issued. REV#1 -CHANGE SHEAR WALL DIMENSION-ISSUED 4/17/19 APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$70000.00 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 369 13 029 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 per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Issued by: Haley McKee OWNER-BUILDER DECLARATION Date:03/29/2019 1 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: 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 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 perfonnance 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 1 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 be deemed revoked. �.-.--�- ...,.... APPLICANT CERTIFICATION Owner or authorized a certify that I have read this application and state that the above information is Date: —� 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 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0400 10530 PINEVILLE AVE CUPERTINO,CA 95014-4529(369 13 029) AAA CONSTRUCTION CUPERTINO,CA 95014 OWNER'S NAME: DATE ISSUED:03/29/2019 OWNER'S PHONE: PHONE NO:(408)728-3854 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#1038374 Contractor AAA CONSTRUCTION Date 04/30/2020 X BLDG X 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: KITCHEN REMODEL(250 SF),REMOVE WALL;REMODEL FAMILY I hereby affirm under penalty of perjury one of the following two declarations: ROOM(285 SF);SECOND FLOOR-CONVERT BEDROOM AREA I have and will maintain Worker's Compensation Insurance,as provided for by (2)NEW WINDOWS,BEDROOM RELOCATE(1)WINDOW,REMOVE Section 3700 of the Labor Code,for the performance of the work for which this FIRE PLACE permit is issued. Sq.Ft Floor Area: Valuation:$70000.00 APPLICANT CERTIFICATION 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 369 13 029 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. Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations 18 Issued by: McKee Yy Date:03/29/2019 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:3/29/18 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. 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 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 Code,Sections 25505,25533,and 25534_ be deemed revoked. Owner or authorized APPLICANT CERTIFICATION Date:3/29/18 certify that I have read this application and state that the above information is CONSTRUCTION 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 3/29/18 Licensed Professional