B-2018-0925 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0925
1282 POPPY WAY CUPERTINO,CA 950141756(366 58 001) APOLLO TB
ELECTRIC
SAN JOSE,CA 95159-
8001
OWNER'S NAME: DATE ISSUED:05/30/2018
OWNER'S PHONE: PHONE NO:(408)275-0880
LICENSED BUILDING PERMIT INFO:
License Class C-10 Lic.#88 68
Contractor APOLLO TB ELECTRIC Date 09130/2018 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 Bustness&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)EV CHARGING STATION(60 AMP)-GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
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.
— aueMmhwill maintain Worker's Compensation Insurance,as provided for by
S tion 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valuation:$850.00
APPLICANT CERTIFICATION
I certify that I have readthis application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupnncy'Iype:
and state laws relating to building construction,and hereby authorize 366 58 001
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 all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/3012018 Issued by:Jasmine Archbold
Date:05/30/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for are of theRE-ROOFS•
folimvhrg two reasons: All roofs shall be inspected prior to any roof ng material being installed.If e roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining at,inspection,1 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. L ss owner of the property,am exclusively contracting with licensed Signature ofApplicanf
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/30/2018
1 hereby affirm under penalty ofperjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
u I have and will maintain a Certificate of Consent to sel&insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of file work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
a 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 California Health&Safety Code,Sections 25505,25533,and 25534,f will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
e. I certify that in the performance of the work for which this permit is issued,[ Health&Safety Code,Section 25532(a)should I stare or handle hazardous
material.Additionally,should 1 use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the .air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California If,after 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 Cif
c,- ctlons 2905,25533,and 25534.
Owner or authorized
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. agen);
APPLICANT CERTIFICATION Date:95!30!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 constructlon 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 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 Date 05!30!2018 Professional