B-2018-0178 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0178
7653 NORMANDY WAY CUPERTINO,CA 95014-5252(366 11 163) CABALLERO'S
CONS
SAN JOSE,CA 95122
OWNER'S NAME:MEHTA OSHA R D 02/2018
OWNER'S PHONE:650-776-5826 PHONE NO:(409)394-0023
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#984387
Contractor CABALLERO'S CONSTRUCTION Date 06/30/2019 X BLDG 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:
FIRST/SECOND FLOOR REMODEL(2047 SF);KITCHEN(200 SF),4-
1 hereby affirm under penalty of perjury one of the following two declarations: BATHROOMS REMODEL(260 SF),CONVERT GARAGE TO MUD
1. I have and will maintain a certificate of consent to self-insure for Worker's ROOM(24 SF);REMOVE DECK(107 SF);GARAGE RE-ROOF-(50
Compensation,as provided for by Section 3700 of the Labor Code,for the SQ);CHANGE GARAGE DOOR
performance of the work for which this permit is issued. REV#1 RELOCATE HARDY PANEL;ADD TO EXISTING BEAM-
1 have and will maintain Worker's Compensation Insurance,as provided for by ISSUED 6/5/2018
Section 3700 or the Labor Code,for die performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$350000.00
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 11 163
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 ap 11 ant understands and will comply with all non-point
source regulations the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 1,6/0512018 Issued by:Jasmine Archbold
- Date:05/02/2018
OWNER-BUILDER ICIARAT.ON
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS,
following two reasons: All roofs shall be inspected prior to any reofing material being installed If a roof is
1. 1,as owner ofthe properly,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials her
compensation,will do the work,and the stmcture is not intended or offered For inspection,
sale(Sec.7044,Business&Professions Code)
1. 1,as owner of tho property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:06/05/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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
pctformance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
e. 1 have and will maintain Worli 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
a. 1 certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ an as to become subject to the naterial.Additionally,should I use equipment or devices which emit hazardous
p y any person in y manner so J am contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the C upertino Municipal Code,Clmpter 9.12 and
exemption,l beconnc subject to the Worker's Compensation provisions of the the Health&Safety Code, ections 25505,25533,and 25534.
Labor Cede,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:06105/2018
I certify that I have read this application and at,the above information Is 1 G 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.
Licensed
Signature Date 06105!2018 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0178
7653 NORMANDY WAY CUPERTINO,CA 95014-5252(366 11 163) CABALLERO'S
CONSTRUCTION
OWNER'S NAME: MEHTA ROMIT P AND KOSHA ISSUED:05/02/2018
OWNER'S PHONE:650-776-5826 PHONE NO:(408)394-0023
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#984387
Contractor CABALLERO'S CONSTRUCTION Date 06/30/2019 X BLDG —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.
nce of the work for which this permit is issued. REV# 1 RELOCATE HARDY PANEL;ADD TO EXISTING BEAM-
2. I have and will maintain Worker's Compensation Insurance,as provided for by ISSUED 6/5/2018
Section 3700 of the Labor Code,for the performance of the work for which this REV#2-CHANGE PANTRY FOR KITCHEN;CHANGE WALL AND
permit is issued. RAIL ON 2ND FLOOR-ISSUED 4/26/19
APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$350000.00
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 366 11 163
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. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant
regulations per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature - X Date 4/26/19
Issued by: Jasmine Archbold
OWNER-BUILDER DECLARATION Date: 05/02/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
1. 1,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:4/26/19
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 performance 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
3. 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(x)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 Code,Sections 25505,25533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION
Owner or authorized agent:
certify that I have read this application and state that the above information is Date:4/26/19
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
understand my plans shall be used as public records.
Signature Date 4/26/19
Licensed
Professional
NO FEE FOR RECORDING PURSUANT TO
GOVERNMENT CODE SECTION 27383
When Recorded Mail To:
City of Cupertino
Community Development Department
10300 Torre Avenue
Cupertino, CA 95014
ll LLouJ»L ILdILI1 IL IL v.-v V V 1 V 01�1�➢y o
Owner's Signature
Print Owner's Name
116I�}�
z
Date
CITY AUTHORIZATION:
ON:
9& lo-wAJ
Erika Poveda, Assistant Planner
24156651
Regina Aloomendras
Santa Clara County - Clerk -Recorder
04/16/2019 12:37 PM
`ides: I Pages: 3
Fees: 10.00
0.00
Taxes: 0
Tolll FAC 0WFI ®41i1%111 011 if, A11.1A 11111
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