Loading...
12060010 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 PINEVILLE AVE CONTRACTOR:CUPERTINO PLUMBING PERMIT NO: 12060010 OWNER'SNAMF.: BARRIECHABELA 1300 DELL AVE STE:C, DATE ISSUED:06/042012 OWNER'S PHONE: 4084550505 CAMPBELL.CA 95008 PDONF.NO:(408)253-0618 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.N MECH r RESIDENTIAL r COMMERCIAL r Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER REPIPE (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 M 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. Sq,FI Floor Area:0 Valualinn:54500 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of(he labor Code,for the performance of the work for which this permit is issued. APN Number:36913032.00 Occupancy Typc: APPLICANT CERTIFICATION I certify that I have read[his application and stale that the above information is t1a correct. I agree(o comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS^OT`STARTED upon(he above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT,ISSU�NCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, e- costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CAIiLED'INSPECTION. a granting of this permit Additionally,(he applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: 4`,y Date: 9.18. Signature Date �+ •� @t, 'rr R ROOFS? ❑ ONVNE:R-BI IILDF.R DECLARATION All roofs shall be inspected prior to any roofing material heng installed.If a roof is installed without first obtaininginspec[iori;1'agrec to remove all new materials for 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. .. )} the following two reasons: 1,as owner of the property.or my employees with wages as their sole compensation. Signature of Appli©n(: !.> Date will do(he work,and Elie s(mc[ure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the propcny,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS 7'O BE CLASS"A"OR BEPI'I'ER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penally of perjury one of the following three IIA?ARDOUS MATERIALS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Ilealth&Safety Code.Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the I leallh& performance ollhe work for which this permit is issued. Safely Code.Section 25532(a)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this coniamina Is as defined by the by Area Air Quality Management District I will permit is issued maintain compliance with the Cupertino Nfunicipal Code.Chapter 9.12 and the Ilealth&Safety Cade,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in an) manner so as In become subject to the Worker's Owner or authorized agent: C'ompensa(ion laws of Calilitrnia. If,alter making this certificate of exemption.I Date: become subject to the Worker's Compensation provisions of the Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked C.ONSTRIICTION LF.\DING AGENCY I hereby affirm that(here is a construction lending agency for the performance ol'twrk's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C) I certify that I have read this application and state(ha(the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize represen(atives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless(he City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCIIITF.CT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records, with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date