B-2018-0162 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0162
10970 LUCKY OAK CT CUPERTINO,CA 95014-0126(326 57 008) DEL VECCHIO
CONSTRUCTION
SUNNYVALE,CA
94086
OWNER'S NAME:
PHONE NO:(40x)202-6439
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 5 Lic.#843433
Contractor DEL VECCHIO CONSTRUCTION Date 07/31/2018 X BLDG—ELECT—PLUMB
1 herebyform that 1 am licensed under the provisions of Chapter 9 _MECH X RESIDENTIAL—COMMERCIAL
a p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
ENCLOSE PORTION OF THE 2ND FLOOR STAIRWELL
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 have and will maintain a certificate of consent to self-insure for Workers
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 ha%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, Sq.Ft Fluor Arca: Valued—$1000(t00
APPLICANT CERTIFICA'T'ION
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 32657 008
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 18D DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ----Date 112612018 Issued by:Abby Avende
Date:91/25/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law 1'.r one of the ItGROOFS•
follmvin two rens....: All root's shall be inspected prior to any roofing material being installed,If a roof is
as owner of the property,or my employees with wages ns their sole installed without first obtaining au inspection,I agree to remove all new nmterials for
o sensation,will do the work,and the structure is not intended or offered for inspection,ur
sale(Sec.7044,Business&Professions Code)
z. I,as owner ofehe property,am exclusively contracting with licensed Signature ofApplicmd:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:1/25/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent t.self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by 1 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 25534.1 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(n)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to tire material.Additionally,should I use equipment or devices which emit hazardous
aircmrtaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificale of will maintain compllanec with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become 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 revoked.
Owner or authorized agent:"'--- -�*-
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 wjlh all Ok->oinL qurce regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Co,\°dey�ecttoli- I understand my plans shall be used as public records.
Sigh tore Date 10512018 Licensed
Professional