BLD-2022-2072_Permit CardCITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO. CA 95014-3255
PHONE 408-777-3228
CUPEERTINU �yd'N.c UPEkllii_�.[�kG
BUILDING ADDRESS: 20343 STEVENS CREEK3LVD APN.31626090
PERMIT NO:SLD-2022-22ar2
OWNER'S NAME: W D V PROPERTIES
OWNER'S PHONE: a1s- 0a 1308a
CONTRACTOR: TH0— LEtCONMUC *N INC
CONTRACTOR PHONE: 4+s-29o-scea
DATE ISSUED:j3a2uzi ISSUED BY:AbbyArad- VALUATION:$100,000
JOB DESCRIPTION: ORANGE SQUARE T.I. - (E) KITCHEN REMODEL, REPLACE HOOD:
REMODEL (E) SERVICE AREA, DINNING AREA; (N) PARTITION WALL; RELOACATE ADA RESTROOM; ELECTICAL, MECHANICAL
PLUMBING; DUCT WORK;
(BLD-202"984)
ACCESSIBLE PATH OF TRAVEL FROM THE PUBLIC WAY AND ACCESSIBLE PARKING - UNDER PERMIT NUMBER BLD-2023-0535
LICENSED CONTRACTOR'S DECLARATION:
CONTRACTOR: 1105482 LICENSED CLASS: B LICENSED NO: 1105482 EXP DATE 6130120H
1 hereby affirm that lam licensed under the provisions of Chapter 9 icummendog s%ith serf van-fjD+!I sf ?z* i tun 3 of the- Bu4ness & Prcr_F_
and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the fallowing three declarations:
D I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by r cliun, 7l q] ur t n,
. ... .: , for the performance of the work for which this permit is issued.
■ T 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.
D 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
R I have read the hazardous materials requirements under Chapter 5.95 of the __ I
will maintain compliance with the 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.
EPA LEAD -SAFE DISCLOSURE
13 An EPA Lead -Safe Certified Renovator will be responsible for this Project.
Certified Firm Name: Finn Certification No:
■ No SPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGEN Y
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)_
Oyes MNo
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 constructiory 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 Carty in consequence of the granting of this permit Additionally, the applicant understands and will comply with all non -paint
source regulations per the i.. unertinu' IUr'HCipal Cute, Section 9 14.
[7
Signature Date 19 113
ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 365 HAYS AFTER ITS ISSUANCE,
�VERYPFRMIT
R THE WORK AUTHORIZED 0N THE SITE BY SUCH PERMIT IS SUSPENDED OR ABANDONED FOR A PERIO0 0F 365 DAYS AFTER THE TIME THE WORK IS COMMENCED.