B-2016-3180CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: b-2016-3180
19946 PORTAL PLZ CUPERTINO, CA 95014-3366 (369 45 025)
RECON360 LLC
SAN JOSE, CA 95118
OWNER'S NAME: PINTO YARON
DATE ISSUED: 11/29/2016
OWNER'S PHONE: 888-277-5580
PHONE NO: (408) 981-3695
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMITINFO:
License Class 13:C=39 Lic. #950805
Contractor RECON360 LLC Date 12/31/2018
X BLDG —ELECT _ 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 FENCE (9 L.F.)
I hereby affirm under penalty ofperjury 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
�"'0°" Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $7825.00
APPLICANT CERTIFICATION
certify that I have read this applicationand 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 45 025
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, 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.
�
Sig" an Lure /y t_ Date 11129/2016
Abl2y A '} nde
Issued by e
Date: 11/29/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
m. L as owner 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
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code) I
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicantr
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 11/29/2016
I 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 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 &c Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. 1 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. 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 provisions or this permit shall
be deemed revoked.Ow
en r or authorized agent:
APPLICANT CERTIFICATION (Date:
11/29/2016
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
CONSTRUC ONLENDINGAGENCY
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 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
DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S
1 understand my plans shall be used as public records.
Code,, Section 9,18.
Licensed
Signature Date 11/29/2016
Professional
r ■ '
cRc
�C q�
MOP- kept at the job
r
i JLw111410 P0
UPERTINO
MMMI
f :nq Department
REVIEWED FOR CODE COMPLIANCE
Reviewed 8y:
61I
Scope
a. R�A1a
wall
Code: ;�013
sung co o mall any changes or
alterations o efrom, without approval
from t e ui mg ficial.
PVe
stS",
thiIand specifications SHALL NOT be
l an approval of the violation of any
p ity Ordinance or State Law.
By Abby Ayende
D TE 1 30/16
�f 1 016-3
Ir
A
pr
'jv,p4/v
Q�
I
W),
G
S'.
�-Y-O%Av WOULt
K.,
a
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION -CUPERTINO
I Jed j -)T PLAKO bVff B.
T a e job
site AITSestru n m any Chan es or
alterations on P s r eto
C , thout approval
i .
The stamping of thQUPaZ$e1kNQs SHALL NOT be
held to permit or to be an approval of the violation of any
provision of any City Ordinance or State Law.
BY Abby A�ende -
ti' 19/3 11 6
PERMIT NO Ej-2016-3180
Qz
CUPERTINO
Building Department
_.-REVIEWS U F_0R_CQDF_LQMPL1ANLE__
Rev'Ejwed +bPY A
_ypnde_,
13 !--.Date: 11/30/16
617
S4-