B-2018-0915 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-20180915
10398 PALO VISTA RD CUPERTINO,CA(357 02 049) P W H ACQUISITION
CO LLC
BOTHELL,WA 98011
OWNER'S NAME: DATE ISSUED:05/29/2018
OWNER'S PHONE: PHONE NO:(425)636-7080
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CL6 Llc.#987398
Contractor W H ACQUISITION CO LLC Date 10/31/2019 X BLDG ELECT X PLUMB
I hereby affirm that I am licensed under the provisions at Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is fn fall force and effect. JOB DESCRIPTION:
(N)50 GAL WATER HEATER-GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
u I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided herby Section 3700 ofthe Labor Code,for the
performance of the work for which this permit is issued.
z 1 have and will maintain Worker's Compensation Insurance,as provided far by
Section 3700 of the Labor Code,for the perforntnnec of the work for which this _
Permit is issued. Sq.Ft Flour Area: Valuation:$164295
APPLICANT CERTiFf('ATION
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: Ocotpancy Type:
and slate laws relating to building construction,and hereby authorize 357 02 049
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
OWN1'ILBUILDER DECLAl2AT'tON
I hereby affirm that I out exempt from the Contractor's License Law 1'or one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any rooting material being installed.If a roof is
r. I,as owner of the property,or my employee with wages as their sole ustalled without first obtaining an uspection,I agree to remove all new materials for
compensation,will do the work,and the suvctare is not intended or offered fin spection.
sale(Scc.7044,Business&Professions Code)
2. 1,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicanC
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. I have and will maintain a Certificate of Consent to self-insure for Walker's
Campers Tion,m provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided Cor by I have read the hazardous materials requironents under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for the performance ofthe work for which this California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
mit is issued. ainhdn compliance with the Cupertino Municipal Code,Chaptm-9.12 and the
Fe m Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. 1 certify that in they person in ofthe work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hnzardoas
shall not employ any person in any manner so as to become subject to the air containments as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after certificate making this of will amfntain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions offs e the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:0512912018
1 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 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 ARCHIT'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data 05129/2018
Professional