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B-2017-0190I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0190 1596 S STELLING RD CUPERTINO, CA 95014-5206 (366 24 048) SMART PLUMBERS INC. SANTA CLARA, CA 95050 OWNER'S NAME: ARORA TARUN AND SHALINI TRUSTEE OWNER'S PHONE: 408-257-2723 LICENSED CONTRACTOR'S DEC .A_� RATION License Class Lic. #930M Contractor SMART PLUMBERS INC. Date 01/31/2019 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. 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by U` Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that 1 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 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 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 and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_"—` " _ v� Date 01/31/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 2. 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. 3. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,: after making this certificate of exemption, I 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 revoked. 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 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 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 and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 01/31/2017 DATE ISSUED: 01/31/2017 PHONE NO: (408) 247-2400 PERMIT INFO: BLDG `ELECT XPLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: .ACE PROPERTY LINE CLEANOUT Ft Floor Area: [Valuation: $2900.00 APN Number: Occupancy Type: 366 24 048 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: RE -ROOFS: 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. Signature of Applicant: Date: 01/31/2017 TO BE CLASS "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2550 25533, and 25534. Owner or authorized agent:. Date: 01/31/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPlERTIEpiO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(a)cupertino.org VpLUMBING n 1,4ECHANICAI MEP MISC �- 2019 -Qlct0 7F_TFC.TR1(-AT. 7_MTC(-..FT.T ANR(ITTS PROJECT ADDRESS ci APN 42 r — e W ONER NAME %�N PHONE E-NAIL STREET ADDRESS "R" CITY STATE, ZIP FAX C -A J CONTACT NAME P ONE EMAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT . CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME%��r� 1�� LICENSE NUMBERLICENSE ®PE TY BUS. LIC # COMPANY NAME C'f c d E-MAIL FAX STREET ADDRESS ARCHITECT/ENGINEER NAME CITYSTATE, ZIP 71"TS7'A ER PHONE BUS. LIC 4 COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY, STATE, ZIP PHONE. USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑COMMERCIAL PROJECT IN RRLDLAND ❑ YES ( PROTECT IN ❑ YES URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO IS TIS' BLDG AN ❑ YES EICHLERHOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: 22, '-- I' By my signature below, I certify to each of the following: I am the property owner or authorized agent to et on the ea . I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accma e. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection.purposes. Signature of Applicant/Agent: Date: / -^ :�2Z—f SUPPLEMENTAL FORMATION REQUIRED OFFICE USEQLI - �%ER-THE-COTdi\TER;�`,•i-C'-s.':�. STANDARD Z. © LARGE ❑ az�JOR MBPM'iscApp_2011.doc revised 06121111 No