B-2018-0918 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0918
7504 KING SBURY PL CUPERTINO,CA 95014-5045(362 30 026) BROTHERS HOME
IMPROVEMENT INC
ROCKLIN,CA 95765
OWNER'S NAME: DATE ISSUED:05/29/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C17-B Lic.4699009
Contractor BROTHERS HOME IMPROVEMENT INC Date 11/30/2018 X BLDG ELECT_PLUMB
1 hereby affirm Hurt 1 nm licensedvrsed ander the provisions of chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
NEW WINDOW LIKE FOR LIKE TO MEET EGRESS(12);SLIDER(2)
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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 Contpensution Insurance,as provided for by
Section 3700 of the Labor Code,for the performance o£the work for which this
permit is issued. Sq.Ft Flom-Arca: Valuation:$10989.00
APPLICANT CERTIFICATION _
I certify that I have read this app"otilion and state that the above
information Is correct.I agree to comply with all city and county ordinances APN Number: Ocrnpancy Type:
and stale laws relating to building construction,and hereby authorize 36230 026
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 IT WORI{IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. j'j'H1N 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations er the Go nit Municipal code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signal— Data 05-29-2018 Issued by:Kim Dunbar
Date:05/29/2018
OWNCTZ-BUI ER D J, IO
I hereby affirm rat I am exempt from the Contractor's License Law 1'm'one of dmRE-ROOFS,
following two reasons: All roofs shall be inspected prior to any racting material being iustxlled.IIa or is
r. 1,as owner oftlre property,or my employees with wages as their sole installed without First obtaining en inspection,I agree to remove all new materials for
compensation,will(lo the work,and the stvchne is not intended or offered for inspection
sale(Scc.7044,Business&Prafcssious Code)
z. 1,as owner ofthe property,ano exclusively contracting with licensed Signature ofApplicaue
contractors to Construct the project(Sec.7044,Business&Professions Code), Date:05-29-2018
I hereby affirm under 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 die Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have rend the Imznrdous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance ot'the work 1'6r which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
r it is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
perm Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
a. 1 certify that in they person in of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any rammer so as to become subject to the aircontaminants us defined by the Ilay 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
exeurpawn,l become subject to the Worker's Compensation provisions of the the Hesdth&Safety Cad actio� 05,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
A 11212AN"j CERTT CATION Data:05-29-2018
certify that I have read this application and state that the have information is N T ,, NG 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 DECLARNFION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data 05-29-2018 Professional