B-2018-0937 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0937
10446 VISTA DR CUPERTINO,CA 95014-2080(3 16 33 074) JOHN SULLIVAN
CONSTRUCTION INC
CAMPBELL,CA 95009
OWNER'S NAME: DATE ISSUED:05/31/2018
OWNER'S PHONE: PHONE NO:(408)247.2147
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 13 Lie.#4=
Contractor JOHN SULLIVAN CONSTRUCTION INC Date 07/31/2019 X BLDG X ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chupter 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 effect. JOB DESCRIPTION:
KITCHEN REMODEL(180 SF);REPLACE WINDOWS(2);PANEL
I hereby affirm tinder penalty of perjury one of the following two declarations: UPGRADE(200 AMP);NEW LIGHTS(7)
t. 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.
I have and will maintain Worker's Compensation Insu mnce,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.IT Floor Arca: Valuation:$30000.00
APPLICANT CERTIFICATION
I certify that I have read this applicallon and state 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 31633 074
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 alf non-point
source regulations art Go erti Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05-31-2018 Issued by:Kim Duch.r
Date:05/31/2018
Thereby affirm that I am exempt from the Contractor's License Low for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected In to any roofing material being installed.If a mof is
r. 1,as owner ofthe 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(See.7044,Business&I'mfesslona Code)
i. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec,7044,Business&Professions Code), Date:05-31-2018
1 hereby affirm ander 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,far the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this Callfmmla Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. ...Ldain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 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 mer so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
p y any person in any mar J air contaminants as defined by the Bay Area Air Quality
Management District I
Worker's Compensation laws o£Cali£ornis.If,after making this certificate of will maintain compliance with the Cupertino onleipel Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S if s ,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed invoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-31-2018
I 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 elty 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. 1 understand my plans shall be used as public records.
Signature Date 05-31-2018 Licensed
Professional