D-2018-0035 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0035
10410 N STELLING RD CUPERTINO,CA 95014-1646.(326 30094) APEX DEVELOPMENT
GROUP LLC
SAN JOSE,CA 95124
OWNER'S NAME:DMJ HOME SOLUTIONS LLC DATE ISSUED:05/29/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#01 33746
Contractor APEX DEVELOPMENT GROUP LLC Dale 12/31/2019 —BLDG—ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
n n (ean,meneing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
DEMO(E)HOUSE-(2373 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
7i 1 have and will maintain Worker's Compensation Insurance,as provided far by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Flom-Area: Valuation:$5000.00
APPLICANTCERTIPICATION
I certify that I have read this application and slate 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 326 30 094
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 05/29/2018 Issued by:Jasmine Archbold
Date:05/29/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one at the RE-ROOFS:
following twa reasons: All..is shall be inspected prior to any roofing material being installed.He roof is
1. I,as owner ofthe property,or my employees with wages as Meir sale installed without first obtaining an inspection,1 agree to remove all new materials for
ompensation,will do the work,and the struentre is not intended or offered for inspection.
.to(So,.7044,Business&Professions Code)
1. 1,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicaue
contractors to construct the project(Sec.7044,Business&Processions Code), Date:05/29/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLASS"A"OR 13E"C'I'F,R
r. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of(lie Labor Code,for the
performance of the work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I Imve rend the hazardous materials requirements order 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 25534.1 will
permit is issued. maintain complinnee with the Cupertino Municipal Code,Chapter 9.12 and fire
3. 1 certify that in the performance ofthe work for which this permit is issued,7 Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ an son in an so a to become subject to the material,Additionally,should 1 use equipment or devices which emit hazardous
1 y• y per y manner J at r contaminants as defined by the Bay Aron Air Quality Management District 1
Worker's Compensation laws of California,If,after making this certifcate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l became subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Leber Code,I mustforthwith comply with such provisions or this permit shall
m –��
be deemed revoked
, Owner or authorized agent:
APPLICANT CERTIFICXTION Date:05/29/2018 '
1 certify that I have read this application and state that the above information is CONSTRUCTION
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 ARCHITECT'S DECLAf2A'1'ION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05/2912018 professional