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B-2018-0858CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0858 10222 BARBARA LN CUPERTINO, CA 95014-2902 (359 12 020) C & D FREITAS CONSTRUCTION INC SANTA CRUZ, CA 95060 ` OWNER'S NAME: DATE ISSUED: 10/26/2018 OWNER'S PHONE: PHONE NO: (408) 353-1900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #286517 Contractor C & D FREITAS CONSTRUCTION INC Date 01/31/2020 X BLDG —ELECT X PLUMB 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 ADDITION FIRST FLOOR -LIVING RM & KITCHEN (236 SF) EXTEND I hereby affirm under penalty of perjury one of the following two declarations: FRONT DOOR (50 SF); KITCHEN REMODEL (192 SF); BATH 1. I have and will maintain a certificate of consent to self -insure for Worker's REMODEL COVERT TO 2 BATHS & MASTER BATH REMODEL (161 Compensation, as provided for by Section 3700 of the Labor Code, for the SF); (2) NEW TANK -LESS WATER HEATER SAME LOCATION, 3- of the work for which this permit is issued. NEW SKYLIGHTS ,,�Vperformance 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 Sq. Ft Floor Area: Valuation: $71000.00 permit is issued. 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 359 12 020 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 regul Lionsrppeer the rtino Municipal Code, Section 1 8. 9 Issued b : Phuon Devries Y t; Date: 10/26/2018 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: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. 1 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 air contaminants as defined by the Bay Area Air ality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance wit Cuperti o Municip 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 & S ety Co , Sec o 55d5 33, and 255534. _ ( / I certify that I have read this application and state that the above information is 40 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 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0858 10222 BARBARA LN CUPERTINO,CA 95014-2902(359 12 020) C&D FREITAS ' CONSTRUCTION IN 95060 NAME: BAXI HIMANSHU AND VAISHALI TRUSTEE DATE ISSUED: 10/26/2018 OWNER'S PHONE:408-582-3240 PHONE NO:(408)353-1900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#286517 Contractor C&D FREITAS CONSTRUCTION INC Date 01/31/2020 X BLDG —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 FIRST FLOOR- G RM&KITCHEN(236 SF)EXTEND I hereby affirm under penalty of perjury one of the following two declarations: FRONT DOOR(50 SF);KITCHEN REMODEL(192 SF);BATH 1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL COVERT TO 2 BATHS&MASTER BATH REMODEL(161 Compensation,as provided for by Section 3700 of the Labor Code,for the SF);(2)NEW TANK-LESS WATER HEATER SAME LOCATION;3- performance of the work for which this permit is issued. NEW SKYLIGHTS I have and will maintain Worker's Compensation Insurance,as provided for by REV#1 -REVISE STRUCTURAL AND ARCHITECTURAL CHANGES Section 3700 of the Labor Code,for the performance of the work for which this TO(2)BATHROOMS;RELOCATE THE DOOR FROM HOUSE TO permit is issued. UE TO THE APPLICANT CERTIFICATION EXISTING GRADE-ISSUED 03/18/2019 certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$71000.00 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 359 12 020 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 7 WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signature '"``"' -> Date 03/18/2019 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUILDER DECLARATION Issued by:Phuong Devries I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 10/26/2018 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 rooting 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. 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:03/18/2019 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 pen-nit 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 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 Owner or authorized agent: relating to building construction,and hereby authorize representatives of this city Date:03/18/2019 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 03/18/2019 1 understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0858 10222 BARBARA LN CUPERTINO,CA 95014-2902(359 12 020) C&D FREITAS CONSTRUCTION INC 95060 OWNER'S NAME: Baxi Himanshu An ustee DATE ISSUED: 10/26/2018 OWNER'S PHONE:408-582-3240 PHONE NO:(408)353-1900 LICENSED CONTRACTOR'S DECLARATION BUILDING-PERMIT INFO: License Class B Lic.#286517 Contractor.0&D FREITAS CONSTRUCTION INC Date 01/31/2020 X BLDG —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: I hereby affirm under penalty of perjury one of the following two declarations: ADDITION FIRST FLOOR-LIVING RM&KITCHEN(236 SF)EXTENDFRONT DOOR(50 SF);KITCHEN REMODEL(192 SF);BATH 1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL COVERT TO 2 BATHS&MASTER BATH REMODEL(161 Compensation,as provided for by Section 3700 of the Labor Code,for the SF);(2)NEW TANK-LESS WATER HEATER SAME LOCATION;3- performance of the work for which this permit is issued. NEW SKYLIGHTS I have and will maintain Worker's Compensation Insurance,as provided for by REV#2-REVISE MASTER BATH LAYOUT-ISSUED 5/20/19 Section 3700 of the Labor Code,for the performance of the work for which this REV#1 -REVISE STRUCTURAL AND ARCHITECTURAL CHANGES permit is issued. TO(2)BATHROOMS;RELOCATE THE DOOR FROM HOUSE TO APPLICANT CERTIFICATION GARAGE;ADJUST FOUNDATION TO ADDITION DUE TO THE I certify that I have read this application and state that the above EXISTING GRADE-ISSUED 03/18/2019 information is correct. I agree to comply with all city and county ordinances Sq.Ft Floor Area: Valuation:$71000.00 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 to save indemnify and keep harmless the APN Number: Occupancy e• City of Cupertino against liabilities,judgments,costs,and expenses which panc y TYp may accrue against said City in consequence of the granting of this permit. 359 12 020 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR ;.---- .� �� Date 5/20/19 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by:Phuong Devries following two reasons: Date: 10/26/2018 1. I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for RE-ROOFS: sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is 2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for contractors to construct the project(Sec.7044,Business&Professions Code). inspection. 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 Signature of Applicant: Compensation,as provided for by Section 3700 of the Labor Code,for the Date:5/20/19 performance of the work for which this permit is issued. 2. 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 3. I certify that in the performance of the work for which this permit is issued,I 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 will Worker's Cornpensation laws of California. If,after making this certificate of 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 the Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: ==_ ' relating to building construction,and hereby authorize representatives of this city Date: 5/20/19 to enter upon the above mentioned property for inspection purposes. (We)agree CONSTRUCTION LENDING AGENCY to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there is a construction lendin agency for the erformance judgments,costs,and expenses which may accrue against said City in g g y p consequence of the granting of this permit. Additionally,the applicant understands'o f 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 Lender's Name Code,Section 9.18. Lender's Address Signature Date 5/20/19 ARCHITECT'S DECLARATION I understand my plans shall be used as public records.