B-2018-0946 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0946
11821 SIERRA SPRING CT CUPPRTINO,CA 95014-5143(366 53 046) Y V CONSTRUCTION
SANTA CLARA,CA
95051
OWNER'SNAME: DATE ISSUED;06/01/2018
OWNER'S PHONE: PHONE NO:(
CONTRACTOR'SLICENSED DECLARATION BUILDING PERMIT INFO:
License Class U Lic.#648432
Contractor Y V CONSTRUCTION Date 06/30/2020 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:
KITCHEN REMODEL(123 SF);IST FLOOR BATH REMODEL(59 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of couscut 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. 1 have and will maintain Worker's Compensation insurance,as provided for by
Section 3700 critic Labor Code,for die performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$8000.00
APPLICANT CERTIFICATION
I certify that I have read this applicallon 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 53 046
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 WORI{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£I upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06-01-2018 Issued by:Kim Dunbar
Date:06/01/2018
OWNER-RUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law fur one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.Ifo roof is
t. I,as owner of the property,or my employees with wages as their sole installed without fust obtaining an inspection,I agree to remove shrew materials for
compensation,will do the Work,and the structure is not intended or offered for inspection.
sale(Sce.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code), Date:06-01-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF 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,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 in for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,Por the performance of the work£or which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issuedm aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 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 hazardous
air Worker's Compensation laws of California.II',after making this certificate of contaminants as defined by the Bay Area Air Quality Management District 1
1 8 will matntsin compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Cade,l must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent: �-
APPLICANT CERTIFICATION Date:06-01-2018
I certify that I have read this application and state that the above information Is CONSTRUWION 1. Y
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 complywith all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 06-01-2018 Professional