B-2018-0967 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0967
10194 BEARDON DR CUPERTINO,CA 95014-1933(326 32 022) MARANATHA
PLUMBING COMPANY
SAN JOSE,CA 95124
OWNER'S NAME:COMMUNITY HOUSING DEVELRS DATE ISSUED:06/06/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=36 Llc.# 9fi
Contractor MARANATHA PLUMBING COMPANY Date 0113 1/2 01 9 X BLDG ELECT X PLUMB
I hereby affirm that[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:
REPLACE 100 GAL WATER HEATER LIKE FOR LIKE IN COMMON
I hereby affirm under penalty of perjury one of the following two declarations: AREA LAUNDRY ROOM
r. 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.
z�cve and will maintain Worker's Compensation Insurance,as provided for by
rm
„^ tion 3700 of the Labor Code,for the performance of the work for which this
it is issued, Sq.Ft Floor Are.: Valuation:$5100.00
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 326 32 022
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,an xpenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue ahe $gt said Clty In consequen a of the gr h g of this permit WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additional the pylic t-nderstands and ill comp all non-point
source r g len s r the upertlno Munic'al o ction 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign D e 06/06/2018 Issued by:Jasmine Archbold
Date:06/06/2018
DF
'LCLATION
hereby of'firm that I art 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 a roof is
1. I,as owner of the property,or my employees with wages as their 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&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:06/06/2018
f hereby affirm under penalty of perjury one of the following three declarations: ALL ROOK COVERINGS TO BE CLASS"A"OR BETTER
r. 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,far 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 In for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for die 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(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 hoz rdous
air contaminants aAage e Be Arco Air Quality Mat
at Rt 1
Worker's Compensation laws of California.If,ager making this certi£cate of will maintain compe r art o uniclpal C�de,CI p e 9.: rod
exemption,I become.subject to the Worker's Compensation provisions of the the healte e tion 25505,2553 and 5
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorizAPPLICANT CERTIFICATION Date:06/06/2018
I certify that I have read this application and statethatthe above Information is TI LE D 'correct.I agree to comply with all city and county ordinances and state laws I hereby affirm thatnstruction 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 ARC"I
DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 06/0612018 Licensed
Professlonal