B-2018-0917 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0917
10163 PARISH PL CUPERTINO,CA 95014-2231(316 44 018) BROTHERS HOME
IMPROVEMENTINC
ROCKLIN,CA 95765
OWNER'S NAME: DATE ISSUED:05/29/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C17-B Lic.#699009
Contractor BROTHERS HOME IMPROVEMENT INC Date 11/30/2018 X BLDG ELECT—PLUMB
1 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 Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE WIDOWS LIKE FOR LIKE TO MEET EGRESS(10);PATIO
I hereby affirm under penalty of perjury one of the following two declarations: DOORS(2)
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.
1 have and will maintain Worker's Compensation Iasureme,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this _
permit is issued. Sq.Ft Fluor Arca: Valuation:$14425.00
APPLICANT CERTIFICATION
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 AIN Number: Occupancy Type:
and stale laws relating to building construction,and hereby authorize 31644019
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 upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05-29-2018 Issued by:Kim Dunbar
Date:05/29/2018
OWNER-BU .,DE ECLAl2ATI0
I hereby at'Hi that I am exempt from the Contractor's License Law fm-one of theREr-ROOPS:
following two reasons: All roofs shell be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner ot'the property,or my employees with wages as their sole installed without trial obtaining or,inspection,I agree ne remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professimrs Code)
z. 1,aowner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sce,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 the 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 hazii 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.I will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance ofthe work for which this permit is issued,l ' He0lttt&Safety Code,Section 25532(a)should 1 store m'handle hazardous
shall not employ any person in an so as to become subject to the material.Addifionatly,should 1 use equipment or devices which emit hazardous
y manner air contaminants as dented by the Bay Area Air Quality Management District l
Worker's Compensation laws of Califenna.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
emption,l become subject to the Worker's Compensation provisions of the fire Health&Safely Code SecHonr5A5 25533,am 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall /J
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-29-2018
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 slate 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
consequenceof 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 OS-29-2018 Professional