Loading...
09080096 REV1 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 1699 S DE ANZA BLVD CONTRACTOR:MS CONSTRUCTION PERMIT NO:09080096 O' 'TR'S NAME: ATAM SANDHU 80 DARRYL DR DATE ISSUED:04/22/2010 OWNER'S PHONE: 4084063158 CAMPBELL,CA 95008 PHONE NO:(408)230-5080 Q LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL ❑ CONSTRUCT 846 SF MASONRY CAR WASH TUNNEL W/CEMENT PLASTER EXTERIOR FINISH,NEW TRASH ENCLOSURE, License Class/y, Liic..# MINOR SITE WORK,TWO(2)NEW DRIVEWAYS,NEW PARKING Contractor/// <`(eV1 f[ r t ate d o ©� I hereby affirm that I am licensed under the provisions of Chapter 9 5/27/10-REVISION#I NEW PROPANE TANK INSTALLATION-REVISION ISSUED (commencing with Section 7000)of Division 3 of the Business&Professions 7/27/10 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: r. I have and will maintain a certificate of consent to self-insure for Worker's Sq,Ft Floor Area: Valuation:$300000 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Occupancy Type: 2. I have and will maintain Worker's Compensation Insurance,as provided for by APN Number:36610120.01 P Y Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR correct.I agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSPECTION. 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, Issued b 'l�lJ Date' 64 costs,and expenses which may accrue against said City in consequence of the r 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 / 3 0�'6 RE-ROOFS: 0 7 gnature �. �+ 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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 sale(Sec.7044,Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 2. I,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I hereby affirm under penalty of ti perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material. i. I have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air Compensation,as provided for by Section 3700 of the Labor Code,for the contaminants as defined by the Bay Area Air Quality Management District I will performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: permit is issued. Date: 3. I certify that in the performance of the work for which this permit is issued,I shal. not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I I hereby affirm that there is a construction lending agency for the performance of work's 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 for which this permit is issued(Sec.3097,Civ C.) revoked. Lender's Name Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct.I agree to comply with all city and county ordinances and state laws relatinl to building construction,and hereby authorize representatives of this city to enter I understand my plans shall be used as public records. the above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless the City of Cupertino against liabilities,judgments, Licensed Professional costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply wit' all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date