B-2017-1710 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1710
10192 DANUBE DR CUPERTINO,CA 95014-2140(369 51 001) MARTZ DESIGNS
PLUMBING
TRACY,CA 95376
OWNER'S NAME: COPE STEPHEN V JRAND MARY G DATE ISSUED: 10/04/2017
OWNER'S PHONE: PHONE NO:(209)640-0222
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
•
License Class B Lic.#1010543 •
•Contractor MARTZ DESIGNS PLUMBING Date 01/31/2018 x BLDG ELECT _PLUMB
MECH X RESIDENTIAL_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
license is in full force and effect. JOB DESCRIPTION:
KITCHEN REMODEL(130 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-REPLACE SUB PANEL(100 AMPS)-ISSUED 10/26/2017
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
(rmance
of the work for which this permit is issued.
e and will maintain Worker's Compensation Insurance,as provided for by
on 3700 of the Labor Code,for the performance of the work for which this
it is issued. Sq.Ft Floor Area: Valuation:$18000.00
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 51 001
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 plicant understands and will comply with all non-point
source egulation per the Cupe ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
"r4g7
- Issued by:ABBY AYENDE
Date: 10/04/2017
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
i. I,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)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:
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&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and.the
3. I 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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 C pertino Munici al Code,Chapter 9.12 and' ,
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ections 25505, 5533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit'shall /
be deemed revoked. , er or authorized agent:
APPLICANT CERTIFICATIONate:
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of thi '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 1:. 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. I understand my plans shall be used as public records.
•
Licensed
Signature Date Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1710
10192 DANUBE DR CUPERTINO,CA 95014-2140(369 51 001) MARTZ DESIGNS
PLUMBING
TRACY,CA 95376
OWNER'S NAME: COPE STEPHEN V JR AND MARY G DATE ISSUED: 10/04/2017
OWNER'S PHONE: PHONE NO:(209)640-0222
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
Libense Class B Lic.#1010543
Contractor MARTZ DESIGNS PLUMBING Date 01/31/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_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
license is in full force and effect. JOB DESCRIPTION:
KITCHEN REMODEL(130 S.F.)
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.
2. I have and'will maintain Worker's Compensation Insurance,as provided for by
Section3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$18000.00
c ce,m 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 51 001
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 regulati s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
10.44,
tune Date 10/4/2017 Issued by:Jasmine Archbold
Date: 10/04/2017
lAk - D ' D_ .t. o►
I hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: o- All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. I,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)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/4/2017
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 forbySection 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&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. I 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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 becothe subject to the Worker's Compensation provisions of the the Health&Safety
• APPLICANT CERTIFICATION r `. 10/4/2017 -
I certify that I have read this,application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws 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
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
• Licensed
Signature Date 10/4/2017 Professional