B-2018-0944 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0944
11141 BUBB RD CUPERTINO,CA 95014-4956(356 20 007) CAPADI LLC
PLEASANTON,CA
94566
OWNER'S NAME: DATE ISSUED:05/31/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#]9209.$1
Contractor CAPADI LLC Date 1113012018 X BLDG_ELECT_PLUMB
I herebyfirm that I am licensed under the provisions of Chapter 9 m —MECH X RESIDENTIAL_COMMERCIAL
a prov p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE WINDOW(11)-LIKE FOR LIKE TO MEET EGRESS;
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE(2)PATIO DOORS-LIKE FOR LIKE
1. 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 Insurance,as provided for by
T Section 3700 of the Labor Code,for the pet formonce of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$10700.00
APPLICANT CFRTIFiCATION
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 356 20 007
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 Ilabillties,judgments,costs,and expenses which PERMIT EXPIRES IF WORT{IS NOT STARTED
may accrue agalnst said City- consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,theap pliant unde stands and will comply with all non-point
source�ire7='— '
d MunlcipalCode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign Date 05131/201 8 Issued by:Jasmine Archbold
Date:05/31/2018
ER- TON
I he by tiflom that Iam exempt tram the Contractor's License Law for one of the RE-ROOFS:
I.61mg two
reasons; All roofs shall be inspected prior to any roofing material being installed.If.r.ori,
i. 1,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:05/31/2018
I hereby affirm under penalty of perjury one 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 of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided far by I have read the hazardous malarial&requirements under Chapter 6.95 of the
Section 3700 ofthe 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. maintain 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(x)should I stare or hurdle 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
Worker's Compensation laws of California.If,after making this certificate of 'contaminants ns defined by the Bay Area Air Quality Mamngement District I
Pel 8 will maintain compliance with the Cuperplhrm t icipal Code,Chapter 9.12 nad
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, 2tions 5505,25533,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:05/3112018
I certify that I have read this application and state that the above information is DI AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there a construction lendin gen or the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per it 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.
Licensed
Signature Data 05/31/2018
Professional