B-2017-1950 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1950
10478 BONNY DR CUPERTINO,CA 95014-2947(359 14 035) DELSUR
CONSTRUCTION
ENTERPRISES
SOUTH SAN .
' FRANCISCO,CA 94083
OWNER'S NAME: DATE ISSUED: 11/14/2017
OWNER'S PHONE: PHONE NO:(415)305-7638
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: '
License Class a Lic.#932951
Contractor DELSUR CONSTRUCTION ENTERPRISES Date 05/31/2019 X BLDG X ELECT X 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:
INSTALL PROPERTY LINE CLEAN OUT;ADD 18 RECESSED
I hereby affirm under penalty of perjury one of the following two declarations: LIGHTS-BEDROOM AND LIVING ROOM;REPLACE ENTRY DOOR
1. I have and will maintain a certificate of consent to self-insure for Worker's
ppensafion,
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
permit is issued. Sq.Ft Floor Area: Valuation:$6000.00
APPLICANT CERTIFICATION
I certify that,l 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 359 14 035
representatives of thiscity 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 icipal Code, -ction 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Date 11/14/2017 Issued by:Abby Ayende
Date: 11/14/2017
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
1. ' I,'as owner of the property,or myemployees with wages as their sole installed without first obtaining an inspection,I agreeto remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,B1isiness&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:11/14/2017
I : ,
I hereby affirm under penalty of perjury'bne 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 wotk: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 theperfoimance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
i, ., material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any pletson'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 Compensanon.laws iof California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,'I becoine"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 aevoked. :
ner or authorized agent: 440111.
APPLICANT,CERTIFICATION Date:11/14/2017
I certify that I have read this applicationand state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to cemply:with'all city'and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to(b'uilding 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 keel?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.
Signature ' ' Date 11/14/2017 Licensed