B-2016-1164BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING
OWNER'S NAME: KABIR HUMAYUN AND NAZNEEN A
OWNER'S PHONE: Not Provided
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 1/6/2020 3:29:10 PM
ISSUED BY: JARCHBOLD
VALUATION: $350000
JOB DESCRIPTION
Construct a two story residence (3735 sq ft); attached garage (400
sq ft). REV #4 - EXTERIOR STONE WORK - ISSUED 08/20/2019 rev #2 - INCREASE CEILING HEIGHT IN ENTRANCE -
ISSUED 7-13-2018 REV #1 - WINDOW DESIGN CHANGE (10) - ISSUED 1 1 /14/2017 DEF #1 - TRUSS PLANS AND CALCS -ISSUED 3-6-2019 REV #3 - ADD (2) SKYLIGHTS ABOVE STAIRS; ADD
(5) NEW WINDOWS FRONT OF HOUSE ON 2ND STORES; ON FIRST FLOOR RAISE THE HEIGHT OF (5) INTERIOR DOORS - ISSUED 06/06/2019
OWNER -BUILDER DECLARATION
I hereby
affirm under penatly of perjury one of the following two
declarations:
I, as owner of the property, or my employees with wages as their role compensation, will do the work, and the structure
is not intended or offered for sale (Sec. 7044, Business
& Professions
Code).
I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business & Professions Code).
I hereby
affirm under penatiy of perjury one of the following two
declarations:
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.
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.
V
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
Compensation
laws of California. If, after making this certificate of 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 be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
V
with
the Cupertino Municipal Code, Chapter 9.12 and the Health
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
equipment
or devices which emit hazardous 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 the Health & Safety Code, Sections 25505, 25533, and 25534.
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified
Firm Name:
Firm Certification No:
v
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby
affirm
under penalty of perjury that there is a construction
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes
V
No
Lender's
Name:
Lender's Address:
APPLICATION 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 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 City of Cupertino against liabilities, judgements, 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.
Signature:
.
.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1164
22552 POPPY DR CUPERTINO,CA 95014-0802(342 12 012) NELSON DANIEL .
RAMOS
HALF MOON BAY,CA
94019
OWNER'S NAME: DATE ISSUED:08/24/2017
OWNER'S PHONE: PHONE NO:(650)834-1260
.__D 1. Y:_:- 0 1_ _,_I_-:,_Y.0` BUILDING PERMIT INFO:
License Class a Lic.#796613
Contractor NELSON DANIEL RAMOS Date 06/30/2019 X BLDG _ELECT =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:
Construct a two story residence(3735 sq ft);attached garage(400 sq ft).
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain"a certificate of consent to self-insure for Worker's
Co.. _, ation,as provided for by Section 3700 of the Labor Code,for the
.e .:-.ice ce of the work for which this permit is issued.
tra I have and will maintain Worker's Compensation Insurance,asprovided for by
"" Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:4135 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 34212 012 Deferred Submittal(R-3),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 CupertinotMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signat 08/24!2017 Issued by:Kim Dunbar
Date:08/24/2017
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. 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:08/24/2017
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. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I 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:08/24/2017
I certify that I have read this application and state that the above information is CONS °UCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances-and state laws I hereby affirm that there isa 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.
Licensed
Signature Date 08/24/2017
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
22552 POPPY DR CUPERTINO, CA 95014-0802 (342 12 012)
OWNER'S NAME:
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #796613
Contractor NELSON DANIEL RAMOS Date 06/30/2019
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.
I hereby affirm under penalty of perjury one of the following two declarations:
1, ,ve 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.
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.
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
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
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.
Date 7-13-2018
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 1, 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
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
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
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.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I trust forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 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.
Signature Date 7-13-2018
CONTRACTOR: PERMIT NO: B-2016-1164
NELSON DANIEL
RAMOS
HALF MOON BAY, CA
94019
DATE ISSUED:08/24/2017
PHONE NO: (650) 834-1260
BUILDING PERMIT INFO
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION.
Construct a two story residence (3735 sq ft); attached garage (400 sq ft).
rev #2 - INCREASE CEILING HEIGHT IN ENTRANCE - ISSUED 7-13-
2018
REV #1 - WINDOW DESIGN CHANGE (10) - ISSUED 11/14/2017
Sq. Ft Floor Area: 4135 I Valuation: $350000.00
APN Number: Occupancy Type:
342 12 012 1 Deferred Submittal (R-3),R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 08/24/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:,
Date:? 13-2018
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date: 7-13-2018
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professio
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1164 '
22552 POPPY DR CUPERTINO,CA 95014-0802(342 12 012) NELSON DANIEL
RAMOS
HALF MOON BAY,CA
94019
OWNER'S NAME: DATE ISSUED:08/24/2017
OWNER'S.PHONE: • PHONE NO:(650)834-1260
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
License Class B tic.#796613 •
Contractor NELSON DANIEL RAMOS Date 06/30/2019 X BLDG _ELECT _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:
Construct a two story residence(3735 sq ft);attached garage(400 sq ft).
I hereby affirm under penalty of perjury.one of the following two declarations: . REV#1-WINDOW DESIGN CHANGE(10)-ISSUED 11/14/2017
'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
,,,ii!,!0. formance of the work for which this permit is issued.
.f . - .nd 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:4135 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 342 12 012 Deferred Submittal(R-3),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'PERIVIIT 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.
e
11/14/2017 Issued by:ABBY AYENDE
Date:08/24/2017 , '
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'rity employees with wages as their sole installed without first obtaining an inspection,I agiee''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 ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors td construct the project(Sec.7044,Business&Professions Code). Date: 11/14/2017
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 willlmaintain a Certificate of Consent to self-insure for Worker's
Compensatidn,las'provided for by Section 3700 of the Labor Code,for the '
performance'df 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. 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 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, , ner or authorized agent? :,
APPLICANT CERTIFICATION de Date:11/14/2017
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 11/14/2017 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1164
22552 POPPY DR CUPERTINO,CA 95014-0802(342 12 012) NELSON DANIEL
RAMOS
HALF MOON BAY,CA
94019
OWNER'S NAME: DATE ISSUED:08/24/2017
OWNER'S PHONE: PHONE NO:(650)834-1260
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#796613
Contractor NELSON DANIEL RAMOS Date 06/30/2019 X BLDG —ELECT —PLUMB
I hereby affirm that 1 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:
Construct a two story residence(3735 sq ft);attached garage(400 sq ft).
I hereby affirm under penalty of perjury one of the following two declarations: rev#2-INCREASE CEILING HEIGHT IN ENTRANCE-ISSUED 7-13-
1. I have and will maintain a certificate of consent to self-insure for Worker's 2018
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1-WINDOW DESIGN CHANGE(10)-ISSUED 11/14/2017
performance of the work for which this permit is issued. DEF#1 -TRUSS PLANS AND CALCS
of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:4135 Valuation:$350000.00
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 342 12 012 Deferred Submittal(R-3),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 3-6-2019 Issued by:Kim Dunbar
Date:08/24/2017
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)
z. 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:3-6-2019
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. 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:3-6-2019
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 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 3-6-2019 Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1164
22552 POPPY DR CUPERTINO,CA 95014-0802(342 12 012) NELSON DANIEL
RAMOS
HALF MOON BAY,CA
94019
OWNER'S NAME: DATE ISSUED:08/24/2017
OWNER'S PHONE: PHONE NO:(650)834-1260
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#796613
Contractor NELSON DANIEL RAMOS 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:
Construct a two story residence(3735 sq ft);attached garage(400 sq ft).
I hereby affirm under penalty of perjury one of the following two declarations: rev#2-INCREASE CEILING HEIGHT IN ENTRANCE-ISSUED 7-13-
1. I have and will maintain a certificate of consent to self-insure for Worker's 2018
VCompensation,as provided for by Section 3700 of the Labor Code,for the REV#1 -WINDOW DESIGN CHANGE(10)-ISSUED 11/14/2017
I have and will maintain Worker's Compensation Insurance,as provided for by REV#3-ADD(2)SKYLIGHTS ABOVE STAIRS;ADD(5)NEW
Section 3700 of the Labor Code,for the performance of the work for which this WINDOWS FRONT OF HOUSE ON 2ND STORES;ON FIRST FLOOR
permit is issued. RAISE THE HEIGHT OF(5)INTERIOR DOORS-ISSUED 06/06/2019
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 Sq.Ft Floor Area:4135 Valuation:$350000.00
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 Type:
City of Cupertino against liabilities,judgments,costs,and expenses which 342 12 012 R-3(Custom)
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 06/06/2019 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BILDER DECLARATION
Issued by:Kim Dunbar
1 hereby affirm that I am exempt from the Contractor's License Law for one of the Date:08/24/2017
following two reasons:
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
I
z. 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: Signature of Applicant:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date:06/06/2019
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
z. 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. 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
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
APPLICANT CERTIFICATION the Health&Safety Code,Sections 25505,25533,and 25534.
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 and state laws Owner or authorized
to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there is a construction lending agency for the performance
judgments,costs,and expenses which may accrue against said City in of work's for which this permit is issued(Sec.3097,Civ C.)
consequence of the granting of this permit. Additionally,the applicant understands Lender's Name
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. Lender's Address
ARCHITECT'S DECLARATION
Signature Date 06/06/2019 1 understand my plans shall be used as public records.
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
r ADDRESS: 22552 poppy DATE: 01//212016 REVIEWED Y: Sear[
APN: BP 'VALUATION: $350,000
'PERMIT TYPE: Building Permit CHECK TYPE. New Construction
PRIMARY T�-
nit? Yes ' Na PENTA 9ATION
USE: L3 �� Duplex PERMIT TYPE- (R3SFC}U�
WORK Construct a two story residence 3735 sg ft • attached garage 00 s .
SCOPE
TYPE I9 FL R AREA
OCCUPANCY TYPE; PC.EIaES I'E:FEE II} RP FEES BP FSE ID
CONSTR. 04
R-3(Custom, II-8,111-6,1V,V-8 4,135 $3,288.46 IR3PLAIC'K $3,610.86 dAnAmSP
TOTALS: 4,135 Tri 28 46` $3,6110.86
,J'VDTE This estimate does not i aclude fees Clue to other Departratents#.e.Planning,Public TYorks,Fire,Sanitaty Server District,School
13isptct ete, . These yes are based on the 2relinzina =information available and are rtndy an estitnate. Contact the Dept for aedcdn'd in a.
FEE I'T'EMS('d?e Resolution 11-03 FEE QTYIFEE MISC ITEMS
Plan Check Fee: $3,28€3.46 Select a Mise Bid Structure
Suppl.PC Fee: Reg. OT 0.0 1ir�s $0.00 or Element of a Building
PME,PlamCheck- $0.00
Permit Fee: $3,610.86
S ppl.Insp.Feer Reg. 0 OT tD.Q hr-- WOO
PME Unit Fee: $0.00
PM.E Permit Fee: $0.00
Construction Tax; Zllc t ms.7:ap, 1
glace $
i33]L�� 8 . 7
Work Without Permit? 0 Yes No $0.00 0
Advanced Plai nine Fee: -ResidentialIPI t�l�fGlt $578.9C3 Select align
Building or Structure
Strona Motion Fee: IRSEISMICR $45-50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $14.60
B`I`OTA . ; $8,221 .00 TOTAL FEE: $x,227.69
Revised: 01101/2€16