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