B-2017-1999 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1999
10699 GASC01GNE DR CUPERTINO,CA 95014-3845(375 31 017) BEYOND
CONSTRUCTION
BUILDERS
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:03/20/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lip.#1445.443
Contractor BEYOND CONSTRUCTION BUILDERS Date Q7/3112019 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —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:
NEW SFD-(2393 SF),ATTACHED GAR(420 SF),PORCH(23 SF)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-COLLECTOR TRUSS ATTACHMENT-ISSUED 8-6-2018
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.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance ofthe work for which this
permit is issued. Sq.Ft Floor Area:2393 Valuation;$430000.00
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 375 31 017 R-3(Alternate Materials)
representatives of this city to enter upon the above mentloned 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/go sequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant and rsta ds and will comply with all non-point
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. 1,as owner of the property,or my employees with wages as thou sole Installed without fust obtaining an inspection,I agree to remove all new inaterials for
compensation,will do the work,and the atmeture is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 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:8-6-2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1 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
z 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,far 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. 1 certify that in the performance of the work for which this permit is issued,I lle.lth&Safety Code,Section 25532(.)shodd I store or handle hazardous
shall not employ any person in any manner so as to become subject to the mate•hd.Additionally,should I use equipment or devices which emft hazardous
Worker's Com any pe laws o£C.lifomia,If,alio become
this subject
to the of air cont.mhrants as defined by the Bay Area Air .ity Management District 1
Pe g will maintain
compliance
with the Cupertino unicip I Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Syd'cty atle,Srotions 05,2 533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a constr on lei g agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued( ec.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
Coda,Section 9.18. 1 understand my plans shall be used as public records.
nature Dale 8-6-20 8 Licensed
Si
9 Professional