B-2018-0951 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-0951
10304 VISTA DR APT B CUPERTINO,CA 95014-2039(316 33 123) BLUE SKY
CONSTRUCTION
SANTA CLARA,CA
95050
OWNER'S NAME: DATE ISSUED:06/04/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.482912
Contractor BLUE SKY CONSTRUCTION Date 12/31/2019 X BLDG X ELECT—PLUMB
1 hereby affirm that 1 am licensed ander the provisions of Chapter 9(commencing MUCH 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(100 SF);FIRST FLOOR BATHROOM
1 hereby affirm under penalty of perjury one of the following two declarations: REMODEL(40 SE);REPLACE PANEL(100 AMP)SAME LOCATION;
t. I have and will maintain a certificate of consent to self-insure for Worker's REPLACE WINDOWS LIKE FOR LIKE TO MEET EGRESS(5)SLIDER
Compensation,as provided for by Section 3700 of the Labor Cade,for the (1)
performance ofthe work for which this permit is issued.
z 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 Floor Arca: Valuation:$45000.00
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 316 33 123
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 WORT{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 per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06-04-2018 Issued by:Kim Dunbar
Date:06/04/2018
OWNER-BUILDER DECLARATION
I 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 a roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I ag,nc to remove all new materials for
compensation,will do the work,and the structure is not intended at offered for inspection.
sale(Scc.7044,Business&Professions Code)
z 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:06-04-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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 die work for which this per is issued. HAZARDOUS MATERIALS DISCLOSURE
z 1 have and will maintain Worker's Compensation Insurance,as provided For by I have read the hazm•dous 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, m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Iacertify that in the performance of the wark for which this permit is issued,I Ilealth&Safety Code,Section 25532(a)should I store or handle hazardous�iall not employ any person In any manner so as to become subject to the material.Additionallymit h
,should 1 use equipment or devices which took air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,aver making this certificate 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 Code,Sections 2550,25533, nd 534.
Labor Cade,1 must for comply with such provisions or this per shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Data:06-04-2018
1 certify that I have read this application and state that the above information Is CONSTRUCTION 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 wfih.11 non-point enrCa regulations per the Cupertino Municipal ARCHI'TECT'S DECI:nItA7'ION
Code,Section 9.1 1 understand my plans shall be used as public records.
Signature Date 06-04-2016 Licensed
Professional