B-2018-1004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1004
11092 CANYON VISTA DR CUPERTINO,CA 95014-5405(356 28 031) SHAWN P BETTEGA
CONSTRUCTION INC
CLOVERDALE,CA
95425
OWNER'S NAME: DATE ISSUED:06/13/2018
OWNER'S PHONE: PHONE NO:(707)8844713
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lin.#585905 X BLDG—ELECT—PLUMB
Contractor SHAWN P BETTEGA CONSTRUCTION INC Date 09/30/2019 —
1 hereby affirm that I am licensed tinder the provisions of Chapter 9(commencing —MECH XX 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:
MASTER BATHROOM REMODEL-(135 SF);REMODEL OTHER AT
1 hereby affirm under penalty of perjury one ofthe following two declarations: MASTER AND GUEST BEDROOMS-(522 SF)
i. 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 ofthe work but which this permit is issued.
1 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: Volcatic.:$25000.00
APPLICANT CF,RTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all clty and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 35628 031
.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 ap licant understands and will comply with all non-point
source regulatio t c p o unicipal code,Section 9.16. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 0611312018 Issued.by:Jasmine Archbold
Date:06/13/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following five reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an 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)
z. I,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Cade), Date:06/13/2018
1 hereby affirm nuclei-penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I how 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Cluapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the wok for which this California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 store o•handle hazardous
shall not employ any person in any manner so as to become subject to time in.'terial,Additionally,should I use equipment or devices which anft hazardaus
air contaminants as defined by the Buy 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 Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health 11 Snf'ety Code,Se tf if SUS, 34.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data:06/1312018
I certify that I have read this application and state that the above Informatlon 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,Clv 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 ARCIIITEC'1"S DECLABATION
Cade,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 06/1312018
Professional