B-2017-1224CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1224
10101 N DE ANZA BLVD CUPERTINO, CA 95014 (326 34 07 1) REDWOOD ELECTRIC
GROUP INC
SANTA CLARA, CA
95051
OWNER'S NAME: WATERDRAGON 289 LLC I I I DATE ISSUED: 07/26/2017 1
OWNER'S PHONE: 650-784-1440
111 -m _1 oa li -,4&2 rrole
License Class CA Lic. #318433
Contractor REDWOOD ELECTRIC GROUP INC Date 01/31/2018
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.
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
PHONE NO: (408) 450-4800
BUILDING PERMIT INFO:
BLDG X ELECT _ PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
DESCRIPTION:
,E - GARAGE; T.I. - REPLACE (E) FLUORESCENT LIGHTS
3 LED; FIXTURES TO MEET T-24 WITH INTEGRATED
CONTROLS
Compensation, as provided for by Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued.
Irhave and will maintain Worker's Compensation Insurance, as provided for by
017, Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. Sq. Ft Floor Area: Valuation: $175000.00
PPLICANT CERTIFICATI
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.
gnature ,� Date 7/26/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
i. 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. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (See.7044, Business & Professions Code).
"N Number: Occupancy Type:
326 34 071
PERMIT EXPIRES IF WORKIS NOT STARTED
WITHIN 180 DAYS OF PERMITISSUANCEOR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby A ede
Date: 07/26/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material beim installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ofApl
Date: 7/26/201
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF'COVERINGS TO BE CLASS "A" OR
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
permit is issued.
3. I 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 7/26/2017
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(a) 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 25505, 25533, arVd 25534.
ner or authorized agent:
Date: 7/26/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's Jor 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
Professional