B-2018-0019CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0019
23500 CRISTO REY DR UNIT 219C CUPERTINO, CA 95014-6525 (342 53 049) BAY AREA
ENTERPRISE
SAN JOSE, CA 95148
OWNER'S NAME: HOLLOWAY ADA R TRUSTEE & ET AL
OWNER'S PHONE: 650-537-1523
LICENSED CONTRACTOR'S DECL•A_RATION
License Class 5 Lic. #817817
Contractor BAY AREA ENTERPRISE Date 03/31/2019
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.
I 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.
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
cc;; m;t is issued.
L , 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 under s and will coin I th all non -point
source regulations pert ino Munich ct 9.1�
Date 1/9/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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(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.
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 1/9/2018
DATE ISSUED: 01/09/2018
PHONE NO: (408) 238-5043
BUILDING PERMIT INFO:
X BLDG $ ELECT X PLUMB
X MECH $ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
UNIT 219C - INSTALL RECESSED LIGHTS (7); REPLACE OUTLETS
(21); LIGHT SWITCHES (12); BATHROOM FANS (2); UPGRADE (2)
SHOWER WALLS AND PAN WITH SOLID CULTURE MARBLE;
UPGRADE SHOWER VALVES
Sq. Ft Floor Area: I Valuation: $12000.00
APN Number:I Occupancy Type:
342 53 049
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby vende
Date: 01/09/2018
RF. -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 Al
Date: 1/9/2018
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 uality Management District I
will maintain compliance with the Cuperti unicipal Code, Chapter 9.12 and
the Health & Safety Code, S ons 25505 5534.
Owner or authorized
Date: 1/9/2018 CONSTRU(TfON"ING AGENCY
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
understand my plans shall be used as public records.
Licensed
Professional