B-2017-0070 Permit CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: P TNO;B-2017-0070
7373 FALLENLEAF LN CUPERTINO,CA 95014(359 27 025) TRIPLE A PLUMBING
SERVICES LET
STINKY DO IT CORP
SANTA CLARA,CA
95054
OWNER'S NAME: FALLEN LEAF SS LLC DATE ISSUED:01/13/2017
OWNER'S PHONE:408-828-2463 PI IONE NO:(408)855-8099
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT D FO:
License Class C36 Lic.#943638
Contractor TRIPLE A PLUMBING SERVICES LET STINKY DO IT CORP Date X BLDG —ELECT —PLUMB
07/31/2018 MECH X RESIDENT _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 JOB DESCRIPTION:
license is in full force and effect. EMERGENCY REPAIR OF STORM',DRAIN PIPING
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
z` ;`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
Sq.Ft Floor Area: Vluation:$2$00.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above APN Number: O cupancy Type:
information is correct.I agree to comply with all city and county ordinances 35917025
and state laws relating 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 PERMIT EXP S IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18. _
Issued by: LI
Signature _,_�U; . � ( Date 01/13/2017 Date:01/13/2017
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm'that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaini ig an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
z. I,as owner of the property,am exclusively contracting with licensed Date:01/13/2017
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COV RINGS TO BE CLASS"A"OR BETTER
1. 1 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 HAZARD, US MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safty Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,S ction 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material.Additionally,shod 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 define by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Saf ty Code, ecti .,s25 05,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the T(lll1
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agel t'i'
be deemed revoked. Date:01/13/2017
APPLICANT CERTIFICATION CONSIIRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this per it is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT";DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans sha I be used as public records.
Code,Section 9.18.
Licensed