B-2016-2718 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2718
10295 EL PRADO WAY CUPERTINO,CA 95014-2623(342 30 014) MARTI'S PLUMBING
SERVICE
CUPERTINO,CA 95014
OWNER'S NAME: FONG MICHAE4 L AND FRANCES R TRUSTEE DATE ISSUED:09/1312016
i
OWNER'S PHONE:650-867-2337 l
PHONE NO:(408)375-3190
LICENSED CONTRACTOR'S DECLARATION_ BUILDING PERMIT INFO:
License Class C-36 Lic.#958020
Contractor MARTI'S PLUMBING SERVICE Date 92/2.8/2017 X BLDG ELECT X 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:
I herebyaffirm under penalty of perjury REPLACE SEWER MAIN AND PROPERTY CLEANOUT.
p ty p J `ry one of the following two 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.
12DI I have and will maintain Worker's Compensation Insurance,as provided for by
ttY'' Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. I
Sq.Ft Floor Area: Valuation:$4850.00
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 30 014
representatives of this city to enter upon the above mentionedproperty 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 ®( �'r/ Issued by.Phuong Devries
'[ Date:09/13/2016
OWNER-BUIL DER DECLA_RA,TION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:,
following two reasons: iAll 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 new materials for
compensation,will do the work,and the structure is not intended or offered for pec on.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of therope exclusively contracting with licensed Sena e o h
p
contractors to construct theproject(Sec.7044,Business&Professions Code). 4 ate:
I hereby affirm under penalty of perjury one of the following three declarations: L R OF 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
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
Worker's Compensation laws of California. ir contaminants as defined by the Bay Area Air Quality Management District I
p alifornia. 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 provision or this permit shall
be deemed revoked. I Owner;or authorized agent:
APPLICANT CERTIFICATION Date:Cts)3-169
1 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 theabove mentioned property for inspection purposes:. (We)agree
Lender's Name
to save indemnify and keep harmless theCity 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 Professional
GENERAL PERMIT APPLICATIONMEP
1-9 CONMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228 • FAX(408)777-3333 buildino(a)cuoertino,orct MISC
CUPERTINU
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DESCRiPTI010F)WORK
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TOTAL\?-:LUATION:
By my signatue below.I cer-uf},to each of the folloN ing: I aIn the property oNvner or authorized agent to act o ` e p�vopam ow er s b half. I have read this
application and the information I have provided is correct. I have read the Description of'Work and verify it is accurate" e to comply with all applicable local
ordinances and state laws relating building construction. I authorize representatives of Cupertino to enter the above-identi wed property for inspection purposes.
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Sigmature of:-":nplicant, o..nt. Date: 1?0—lie
SliPPLE'NIENTAL IINFOR>IATIOI T REQUIRED `r
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