B-2019-0362 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0362
1436 S STELLING RD CUPERTINO,CA 95014-5245(366 17 093) ALI'S CONSTRUCTION
&REMODELING INC
SAN JOSE,CA 95129
OWNER'S NAME: DATE ISSUED:05/31/2019
OWNER'S PHONE: PHONE NO:(408)441-0967
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#909433
Contractor ALI'S CONSTRUCTION&REMODELING INC Date 01/31/2020 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:
ADD(783 SF)TO CREATE ENTRY,LIVING,BEDROOM 3&41
I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM 3;(1)BAY WINDOW-(19 SF)AT REAR;REMODEL
1. I have and will maintain a certificate of consent to self-insure for Worker's OTHER(280 SF);REMODEL KITCHEN(250 SF);(1)COVERED
Compensation,as provided for by Section 3700 of the Labor Code,for the PORCH(50 SF);UPGRADE MAIN PANEL(200 AMP);(N)FURNACE-
performance of the work for which this permit is issued. GARAGE;(N)WATER HEATER-GARAGE;CONVERT(3 5 SF)OF
issued. Sq.Ft Floor Area:783 Valuation:$180000.00
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
366 Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 366 17 093 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 PERM
Additionally,the applicant understands and will comply with all non-point IT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature /' Date 05/31/2019 Issued by:Jasmine Archbold
Date:05/31/2019
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:05/31/2019
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
perfonnance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. 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 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 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 25505,255339 d 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/31/2019
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. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05/31/2019 Professional
BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS:
OWNER'S NAME: Not provided
OWNER'S PHONE: Not Provided
CONTRACTOR:
ALI'S CONSTRUCTION & REMODELING INC, 1011 S DE ANZA BLVD SAN JOSE
CONTRACTOR PHONE:
4084410967
DATE ISSUED 11/6/2019 11:03:41 AM
ISSUED BY: KDUNBAR
VALUATION: $180000
JOB DESCRIPTION
3; (1) BAY WINDOW - (19 SF) AT REAR; REMODEL OTHER (280 SF); REMODEL KITCHEN (250 SF); (1) COVERED
GARAGE; (N) WATER HEATER - GARAGE; CONVERT (35 SF) OF GARAGE TO POWDER ROOM REV #1 - UPDATED
CALCS AND LAYOUT - ISSUED 11-29-2019
ADD (783 SF) TO CREATE ENTRY, LIVING, BEDROOM 3 & 4, BATHROOM
PORCH (50 SF); UPGRADE MAIN PANEL (200 AMP); (N) FURNACE -
SOIL REPORT AND REVIEW LETTER- ISSUED 11-2019 DEF # 1 - TRUSS
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
ALI'S
LICENSED
B GENERAL
LICENSED
909433
EXP
01/31/2020
I hereby
force
I hereby
CONSTRUCTION
CLASS:
BUILDING
NO:
DATE:
affirm
and effect.
affirm
I have and
for which
I have and
I certify that
with
& REMODELING INC
CONTRACTOR
that I am licensed under the provisions of Chapter
under penatly of perjury one of the following three
will maintain a certificate of consent to self -insure
this permit is issued.
will maintain Worker's Compensation Insurance,
in the performance of the work for which this permit
laws of California. If, after making this certificate
such provisions or this permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
An EPA Lead -Safe Certified Renovator will be responsible for
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
information is correct. I agree to comply with all city and county ordinances and state laws relating to building