B-2019-0648 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0648
7597 PROSPECT RD CUPERTINO,CA 95014-5242(366 24 036) OWNER/BUILDER
7597 Prospect Rd
Cupertino,CA 95014
OWNER'S NAME: ( DATE ISSUED:04/16/2019
OWNER'S PHONE: PHONE NO:408-307-8489
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor OWNER/BUILDER Date X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
UPGRADE MAIN PANEL SAME LOCATION-(200 AMP)
I hereby affirm under penalty of perjury one of the following two declarations: REV# 1 REMODEL KITCHEN(128 SF)LIKE FOR LIKE;REMODEL
1. I have and will maintain a certificate of consent to self-insure for Worker's (3)BATHROOMS LIKE FOR LIKE-(240 SF);INSTALL SUB-PANEL
Compensation,as provided for by Section 3700 of the Labor Code,for the (125 AMP)IN LAUNDRY ROOM;INSTALL(48)RECESSED LIGHTS;
performance of the work for which this permit is issued. INSTALL/REPLACE(68)PLUGS AND SWITCHES;INSTALL 3/4"
2. I have and will maintain Worker's Compensation Insurance,as provided for by GALVANIZED GAS LINE FROM METER TO COOK-TOP(18,000
Section 3700 of the Labor Code,for the perfonnance of the work for which this BTU); ISSUED 04/22/2019
permit is issued. REV#2-ADD(N)A/C IN BACKYARD;REPLACE DUCTWORK;
APPLICANT CERTIFICATION REPLACE SUB-FLOOR(96 SF)IN KITCHEN-ISSUED 5/13/19
1 certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$31500.00
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 24 036
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 5/13/19 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by: Jasmine Archbold
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 04/16/2019
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
2. 1,as owner of the property,am exclusively contracting with licensed inspection.
eqcontractors to construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Date:5/13/19
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. 1 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 malting 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, ections 25505,25533,and 25534.
APPLICANT CERTIFICATION
I 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 laws Date: 5/13/19
relating to building construction,and hereby authorize representatives of this city CONSTRU N 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. j
ARCHITECT'S DECLARATION
Signature Date 5/13/19 1 understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0648
7597 PROSPECT RD CUPERTINO,CA 95014-5242(366 24 036) (Mayank Verma And
Indu Verma)
7597 Prospect Rd
Cupertino,CA 95014
OWNER'S NAME: ( DATE ISSUED:04/16/2019
OWNER'S PHONE: PHONE NO:408-307-8489
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor(Mayank Verma And Indu Verma)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:
UPGRADE MAIN PANEL SAME LOCATION-(200 AMP)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1 REMODEL KITCHEN(128 SF)LIKE FOR LIKE;REMODEL
1. I have and will maintain a certificate of consent to self-insure for Worker's (3)BATHROOMS LIKE FOR LIKE-(240 SF);INSTALL SUB-PANEL
Compensation,as provided for by Section 3700 of the Labor Code,for the (125 AMP)1N LAUNDRY ROOM;INSTALL(48)RECESSED LIGHTS;
performance of the work for which this permit is issued. INSTALL/REPLACE(68)PLUGS AND SWITCHES;INSTALL 3/4"
2. I have and will maintain Worker's Compensation Insurance,as provided for by GALVANIZED GAS LINE FROM METER TO COOK-TOP(18,000
Section 3700 of the Labor Code,for the performance of the work for which this BTU); ISSUED 04/22/2019
permit is issued.
Sq.Ft Floor Area: Valuation:$31500.00
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 366 24 036
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 04/22/2019 Issued by:Jasmine Archbold
Date:04/16/2019
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
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). pp
' Date:04/22/2019
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
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 l use equipment r
s Compensation laws of California. If,after making this certificate of 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
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 the Health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:04/22/2019
I certify that I have read this application and state that the above information is CONSTRUCTIC+LP ° NDING 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 04/22/2019 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0648
7597 PROSPECT RD CUPERTINO,CA 95014-5242(366 24 036) Hall Denny S Trustee
1159 Archer Way
Campbell,CA 95008-
5135
OWNER'S NAME: DATE ISSUED:04/16/2019
OWNER'S PHONE: PHONE NO:4408-307-8489
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Hall Denny S Trustee Date 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:
UPGRADE MAIN PANEL SAME LOCATION-(200 AMP)
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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. Sq.Ft Floor Area: Valuation:$1500.00
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 36624036
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 04/16/2019 Issued by:Jasmine Archbold
Date:04/16/2019
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
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:04/16/2019
I 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,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
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 Workers 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: 04/16/2019
I 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. I understand my plans shall be used as public records.
Signature Date 04/16/2019 Licensed
Professional