B-2018-1966 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1966
18660 RUNO CT CUPERTINO,CA 95014-3865(375 25 029)
OWNER'S NAME: DATE ISSUED:03/28/2019
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Date 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:
I hereby affirm under penalty of perjury one of the following two declarations: ADDITION FIRST FLOOR(1000 SF);(N)PORCH(49 SF);(N)ATTACHED GARAGE(504 SF);REMODEL BATHROOM( 7 2 4 SF),
1. I have and will maintain a certificate of consent to self-insure for Workers MODEL KITCHEN(140 SF);REMODEL OTHER 957 SF
Compensation,as provided for by Section 3700 of the Labor Code,for the UPGRADE MAIN PA ( )'
NEL(200 AMPS);(N)SUB-PANEL(100 AMPS)
performance of the work for which this permit is issued. GARAGE;(N)FURNACE;(N)A/C;(N)WATER HEATER;
i. I have and will maintain Worker's Compensation Insurance,as provided for by WASHER/DRYER•REMOVE E (N)Section 3700 of the Labor Code,for the performance of the work for which this � ( )UTILITY ROOM(-188 SF);FULLY
SPRINKLER BLDG;RELOCATE POOL EQUIPMENT
permit is issued. REV#I -RAISE THE ADDITION FLOOR BY 611
•REBUILD
APPLICANT CERTIFICATION EXTERNAL WALL TO COMPLY WITH CURRENT BUILDING CODES
I certify that I have read this application and state that the above -ISSUED 5/29/19
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: Valuation:$25000.00
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 75 Number: Occupancy Type:
3
may accrue against said City in consequence of the granting of this permit. 375 25 029 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
Signature Date 5/29/19 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 Issued by:Kim Dunbar
following two reasons: Date:03/28/2019
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
= installed without first obtaining an inspection,I agree to remove all new mater'
contractors to construct the project(Sec.7044,Business&Professions Cod materials for
inspection.
I hereby affirm under penalty of perjury one of the following three declarations:
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 I certify that in the performance of the work for which this permit is issued,I OSURE
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
Worker's Compensation laws of California. If,after makingthis certificate of will
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
I certify that I have read this application and state that the above information is the Health&Safety Code,Sections 25505,25533,and 25534.
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 or authorized agent.
to enter upon the above mentioned property for inspection purposes. (We)agree Date:5/29/19
to save indemnify and keep harmless the City of Cupertino against liabilities, CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
judgments,costs,and expenses which may accrue against said City in
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 Lenders Name
Code, Section 9.18.
_ Lender's Address
5/29/19 ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1966
18660 RUNO CT CUPERTINO,CA 95014-3865(375 25 029) OWNER/BUILDER
OWNER'S NAME: DATE ISSUED:03/28/2019
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor OWNER/BUILDER Date 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:
ADDITION FIRST FLOOR(1000 SF);(N)PORCH(49 SF);(N)
I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE(504 SF);REMODEL BATHROOM(274 SF);
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL KITCHEN(140 SF);REMODEL OTHER(957 SF);
Compensation,as provided for by Section 3700 of the Labor Code,for the UPGRADE MAIN PANEL(200 AMPS);(N)SUB-PANEL(100 AMPS)
performance of the work for which this permit is issued. GARAGE;(N)FURNACE;(N)A/C;(N)WATER HEATER;(N)
2. I have and will maintain Worker's Compensation Insurance,as provided for by WASHER/DRYER;REMOVE(E)UTILITY ROOM(-188 SF);FULLY
Section 3700 of the Labor Code,for the performance of the work for which this SPRINKLER BLDG;RELOCATE POOL EQUIPMENT
pen-nit is issued.
Sq.Ft Floor Area: Valuation:$25000.00
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 37525 029 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
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 per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 3-28-2019 Issued by:Kim Dunbar
Date:03/28/2019
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:3-28-2019
I hereby a�firm under penalty of perjury one of the following three declarations:
1. 1 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 pen-nit 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 pennit 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
be deemed revoked.
Owner or authorized agent:.........
APPLICANT CERTIFICATION Date:3-28-2019
1 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 �- .--� �ApM Date 3-28-2019
Licensed
Professional