B-2018-0673 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0673
10777 W ESTATES DR CUPERTINO,CA 95014-4535(369 23 030) DAYLITE
DIMENSIONS
CERES,CA 95307
OWNER'S NAME: DATE ISSUED:04/24/2018
OWNER'S PHONE: PHONE No:(209)480-1995
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.#84]704
Contractor DAYLITE DIMENSIONS Date 04/30/2020 X BLDG ELECT_PLUMB
1 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 farce and offer. JOB DESCRIPTION:
INSTALL LATTCE COVER(238 S.F.)
I hereby affirm under penalty of pm•jury one of the following two declarations:
1. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of the work£or which this permit is issued.
Section 3700 of the Labor Code,for the performance of the work for which this
Ppermit is issued. Sq.Ft Floor Area: Valuation:$2500.00
APPLICANT CERTiPiCATiON
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 stale laws relating to building construction,and hereby authorize 36923 030
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 regulgtlo s p e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature '� �/ Date 04-24-2018 Issued by:Kim Dunbar
Date:04/24/2018
' -BUI DER DECLARATI
I hereby 'rat that I an exempt from the Contractor's License Lawlor one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If's roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 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&Professions Code)
2. f,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04-24-2018
1 hereby affirm ander penalty of perjury ane of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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 ofthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chaplet 6.95 of Bre
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. aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a 1 certify that in die performance of the work for which this permit is issued,I n Health&Safety Code,Settlou 25532(.)should 1 store or handle hazardous
shall not employ n person in at manner so as to become subject to the material.Additionally,Should 1 use equipment at-devices which emit hazardous
p y a y p y man J air conhtmmants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,a0cr making this cenifleate of will maintain compliance with the Cupertino Municiptd Cade,Chapter9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio ;25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:04-24-2018
I certify that I have read this application and state that the above information is CO SIR C ON I Di ENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is c nstruction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this perms 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
Cade,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 04-24-2018 Licensed
Professlmost