B-2018-0526 REV#2 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0526
7495 PROSPECT RD CUPERTINO,CA 95014-5241(366 15 053) UPPAL
CONSTRUCTION
COMPANY
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:03/29/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.#893295
Contractor UPPAL CONSTRUCTION COMPANY Date 0 313 112 0 1 9 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed ander 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 fall furca and effect. JOB DESCRIPTION:
KITCHEN REMODEL(144 S.F.);PANEL UPGRADE(200 AMPS)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-REMODEL 2 BATHROOMS(72 SF);NEW LATERAL CLEAN-
t. I have and will maintain a certificate of consent to sel&insure for Worker's OUTS HOUSE AND PROPERTY LINE;BURY EXISTTNG WATER LINE
Compensation,as provided for by Section 3700 of the Labor Code,For the -ISSUED 4-9-2018
performance of the work For which this permit is issued. REV#2-RE-STUCCO(930 SF)-ISSUED 4/24/2018
1 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. Sq.Ft Flom Area: Valuation:$49000,00
APPLICANT CERTIFICATION
I certify that I have read this application and stale 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 366 15 053
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 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations
Date 04-24-2018 Issued by:Abby Avende
Date:03/29/2018
OWNER-BUILDER DECLARATION
1 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. of is
c 1,as owner of the property,or my employees with wages as their sole installed without fust obtaining an inspection,I agree to reuove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Prefeetheis Cade)
i. 1,as owner of the property,am exclusively contracting with licensed Signature o£Applicanl:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04-24-2018
1 hereby affirm under penalty of perjury one of the following three declnrntions: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTOR
L 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided Por by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I force read the hazmdea s materfals 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
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(.)should 1 store or handle hazardous
shall not employ m in so as to become subject to the material.Additionally,should I use equipment or devices which emit to—rdous
p y: y person any m.inner 1 air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,atter making this certiftoate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,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:
APPLICANT CERTIFICATION Date:04-24-2018
1 certify that I have read this application and stale that the above information is CONS'fRUC'f10N LENDING 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,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
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Data 04-24-2018 Licensed
Professional