B-2018-1977 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1977
7656 RAINBOW DR CUUPERTINO,CA 95014-5247(366 11 032) OWNER/BUILDER
OWNER'S NAME: DATE ISSUED:03/04/2019
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 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(892 SF)GUEST BEDROOM,MASTER BATH,OFFICE,
I hereby affirm under penalty of perjury one of the following two declarations: DTNTNG AREA,LIVING ROOM;(N)PORCH(16 SF);ADDITION(100
1. I have and will maintain a certificate of consent to self-insure for Worker's SF)GARAGE;REMODEL MASTER BEDROOM(249 SF);(E)
Compensation,as provided for by Section 3700 of the Labor Code,for the GARAGE CONVERSION(120 SF);ELECTRICAL PANEL UPGRADE
performance of the work for which this permit is issued. (200 AMP);RELOCATE WATER HEATER IN GARAGE(40 GAL);
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by DEMOLISH REAR COVERED PORCH(200 SF).
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:892 Valuation:$150940.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above APN
information is correct. I agree to comply with all city and county ordinances Number: Occupancy Type:
366
and state laws relating to building construction,and hereby authorize 366 11 032 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. 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.
Signature Date 3-4-2019 Issued by:Kim Dunbar
Date: 03/04/2019
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.3-4-2019
1 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,foi-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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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,
Owner or authorized agent:
APPLICANT CERTIFICATION Date:3-4-2019
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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1977
7656 RAINBOW DR CUPERTINO,CA 95014-5247(366 11 032) OWNER/BUILDER
OWNER'S NAME: DATE ISSUED:03/104/2019
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 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(892 SF)GUEST BEDROOM,MASTER BATH,OFFICE,
I hereby affirm under penalty of perjury one of the following two declarations: DINING AREA,LIVING ROOM;(N)PORCH(16 SF);ADDITION(100
1. I have and will maintain a certificate of consent to self-insure for Worker's SF)GARAGE;REMODEL MASTER BEDROOM(249 SF);(E)
Compensation,as provided for by Section 3700 of the Labor Code,for the GARAGE CONVERSION(120 SF);ELECTRICAL PANEL UPGRADE
performance of the work for which this permit is issued. (200 AMP);RELOCATE WATER HEATER IN GARAGE(40 GAL);
2. I have and will maintain Worker's Compensation Insurance,as provided for by DEMOLISH REAR COVERED PORCH(200 SF)
Section 3700 of the Labor Code,for the performance of the work for which this REV#1 -REVISE LAUNDRY AND HALF BATH LAYOUT;REPLACE
pen-nit is issued. EXISTING WATER HEATER TO TANKLESS WATER HEATER-ISSUED
APPLICANT CERTIFICATION 4-3-2019
1 certify that I have read this application and state that the above Sq.Ft Floor Area:892 Valuation:$150940.00
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 366 11 032 R-3(Custom)
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. PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature Date 4-3-2019 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by:Kim Dunbar
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date:03/04/2019
following two reasons:
1. I,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
1,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:4-3-2019
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 Owner or authorized agent:
correct.I agree to comply with all city and county ordinances and state lawsr
Date:4-3-2019
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree CONSTRUCTION LENDING AGENCY
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 4-3-2019
1 understand my plans shall be used as public records.
Licensed