B-2018-0923 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0923
23500 CRISTO REY DR UNIT 413G CUPERTINO,CA 95014-6532(342 53 t95) BAY AREA
ENTERPRISE
SAN JOSE,CA 95148
OWNER'S NAME: DATE ISSUED:05/30/2018
OWNER'S PHONE: PHONE NO:(408)238-5043
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class B Lic.#817817
Contractor BAYAREA ENTERPRISE Date 43/31/2019 X BLDG X ELECT X PLUMB
I herebyaffirm that 1 am licensed under the provisions of Cha ter 9 omnsendn X MECH X RESIDENTIAL_COMMERCIAL
a pravi p (e g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is fa full force and effect. JOB DESCRIPTION:
THE FORUM#413G-1)CHANGE(5)LIGHTS TO LED LIGHTS;2)
1 hereby affirm under penalty of perjury one of the following two declarations: REPLACE(17)OUTLETS;3)REPLACE(10)EXISTING SWITCHES;4)
1. 1 have and will maintain a certificate of consent to self-insure for Worker's REPLACE(I)BATH FAN;5)UPGRADE(1)SHOWER FIXTURE AND
Compensation,as provided for by Section 3700 of the Labor Code,for the SHOWER PAN/SURROUNG
performance o£the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
(/ Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$12000.00
APPLICANT CERTIFICATION
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 slate laws relating to building construction,and hereby authorize 342 53 195
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 urs lands and will comply with all non-point
source regulations r N�¢Gmtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Si ' Date 05/30/2018 Issued by:Jasmine Archbold
Date:05/30/2018
OWNER-BUILDER DECLARATION
1 bcral nl'Hrm that I am exempt from the Contractor's License Law for our of theRE-ROOFS
following two reasmns: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining no 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)
1. 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:05/30/2018
f hereby affirm under penalty of perjury are ol'tire following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER1. 1 have and will maintain a Certificate of Conscnt to self-instae for Worker's
Compensation,.as provided for by Section 3700 of the Labor Cade,For the
performance of tire work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hvardeas materials requirements under Chapter-6.95 of the
Section 3700 of the Labor Code,for the performance of the woiic for which this California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
penult Is maintain aintain compliance with the Cupertino Municipal Code,Clmpter 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 25-532(x)should 1 stare 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
r contaminants as defined by tine Bay Area Air Quality Management District I
Worker's Compensation laws of Califaria.ff,after nnaking this certificate of will maintain complin a Pith the Cn nicipal Code,Chapter 9.12 aad
exemption,l beconc subject to the Worker's Compensation pro,dors of time the Hodt &Saf actions 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized tint -
APPLICANT CERTIFICATION Data:05/30/2018
1 certify that 1 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 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 Q5/30/2018 Professional