B-2018-0031 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0031
1053 WEST HILL CT CUPERTINO,CA 95014-5063(362 27 050) REMODELWEST
CONSTRUCTION INC
SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED:02/20/2018
OWNER'S PHONE:408-655-9569 PHONE NO:(408)257-4900
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ll Lie.#080453
Contractor REMODELWEST CONSTRUCTION INC Date 11130/2019 a BLDG ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing x MECH X RESIDENTIAL_COMMERCIAL
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(3 18 S.F.);BATHROOM REMODEL(315 ST);
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL LIVING ROOM AND FAMILY ROOM(153 SR);REPLACE
1. I have and will maintain a certificate of consent to self-insure for Worker's FURNACE AND HVAC;REPLACE WINDOWS(21)AND PATIO DOOR
Compensation,as provided for by Section 3700 of the Labor Code,for the. (1)
performance of the work for which this permit is issued. REV#1-REPLACE HEADER AT KITCHEN EXTERIOR DOOR;
/14avrait
have and will ma stain Worker's Compensation Insurance,as provided for by RELOCATE COLD AIR RET IN MASTER BEDROOM;ADD 2
ectioa 3700 of the Labor Code,for the performance of the work for which this SUN TUNNELS is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$27500.00
I certify that 1 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 362 27 050
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.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulati s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM
/LAST/C9A�LLED INSPECTION.
Signature Date 512010 g I,tyy,7L( 1 A thlu -
Issued by;Jeffrey5�amura•"� _( s' l
Date:02/20/2018
QMWER- U L DECLARATION
I hereby affirm that 1 an exempt from the Contractor's License Law for are of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior m any roo£mg material being installed,If a roof is
1. I,w owner of the property,or my employees with wages as thew 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&Professims Code)
z. I,as owner of the property,am exclusively contracting with licensed Signalme of Applicant:
contractors to construct the project(See.7044,Business&Professions Cade). Date:5/17/2018
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
e. 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
Worker's Compensation laws of California.If,after making this certificate of air contaminants as defined by the Bay Area AU Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 aad
Labor Code,I most forthwith comply with such provisions or this permit shall the Health&Safely;IION
tiopns 25505,25533,and 25534.
be deemed revoked. Owner11 authorized agentAPPLICANT CERTIFICATION Date:5/1712018
1 certify that I have read this application and state that the above Information is C TRENDING 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,ON 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. 1 understand my plans shall be used as public records.
Signature Date 511712018 Licensed
Professional