B-2016-2773 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2773
10683 S BLANEYAVE CUPERTINO,CA-95014-4542(369 33 011) GLADIATOR REPIPE
INC
SAN JOSE,CA 95136
OWNER'S NAME: WAN YIYUN AND HUANG SHU-YUP DATE ISSUED:09/21/2016
OWNER'S PHONE:408-865-1825 PHONE NO:(408)444-2696
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C--.3f Lia#1008291
Contractor GLADIATOR REPIPE INC Date 10/31/2017 X BLDG _ELECT X 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:
REPLACE BUILDING SEWER
I hereby affirm under penalty of perjury 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.
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. Sq.Ft Floor Area: Valuation:$3500.00
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 369 33 011
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 a 'nst liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue again aid City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,th pp��cant understands and will comply with all non-point
source regulati s er the Cupertino Municipal Code,sectio .18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature _
g Date 9 21-2016 Issued by:Kim Dunbar
Date:09/21/2016
iDECLARATION
I hereby affirm th I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two rea All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as o er 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
com, ti n,will do the work,and the structure is not intended or offered for inspection.
sale(Sec. 0 4,Business&Professions Code)
i. I,as owne f the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sce.7044,Business&Professions Code). Date:9-21-2016
1 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 forby Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
Z. 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. 1 will
permit is issued. maintain compliance with the Cu ertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 32(a)should I store dle hazardous
shall not employ any person in any manner so as to'become subject to the material. Additionally,s d I se qui ent or d ces which a it hazardo
air contaminants as de ed by t e ay Area Air ality Managemen Dist ' t I
Worker's Compensation laws of California. If,after making this certificate of wn maintain complian a with th C pertino M 'cip Code,Chapte 9. and
exemption,I become subject to the Worker's Compensation provisions of the the Health& ety o , ections 25 05,255 and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Ow er or authorized agent:
APPLICANT CERTIFICATION Date�- -
I
certify that I have read this application and state that the above information is T TI 1' 4GENCY
correct.I agree to comply with all city and county ordinances and state laws I hereyairhat there is a construct�n 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 ec.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. 1 understand my plans shall be used as public records.
Licensed
Signature Date 9-21-2016 Professional
GENERAL PERMIT APPLICATIONMEV
COMMUNI I DEVELOPIdiENT DEPARTMIENT BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
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application and&.e tlnio:,nation I have ro�ided is r,ect. I hay,e read yhe Desc;ption of-%Vork and verify it is accurate. I agree to inply';v th all applicable local
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