D-2018-0040 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0040
19914 WHEATON DR CUPERTINO,CA 95014-2338(316 21 081) PHILLIP D BIURMAN
SARATOGA,CA 95070
OWNER'S NAME: DATE ISSUED:06/13/2018
OWNER'S PHONE: PHONE NO:(650)906.7533
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B U..4876250
Contractor PHILLIP D BJURMAN Date 04/30/2020 —BLDG ELECT_PLUMB
[hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
DEMO SWIMMING POOL-(740 SF)COMPACTION REPORT TO BE
I hereby affirm under penalty of perjury one of the fallowing two declarations: PROVIDED AT FINAL
r. I have and will maintain a certificate o£consent to self-insure for Worker's
Compensation,as provided for by Section 3700 cribs Labor Code,for dre
�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: Valuation:$1000.00
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 316 21 081
representatives of this city to enter upon the above mentioned properly 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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature—\� '/. Date 06/13/2018 Issued by:Jasmine Archbald
Date:06/13/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the REOFS:
following two reasons: All roof's shall be inspected prior to an-ROy roofing material being installed.II'a roof is
r. 1,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 of the property,am exclusively contracting with licensed Signature ofApplicaup
contractors to construct the project(Scc.7044,Business&Professions Code). Date:06/13/2018
I hereby affirm nuclei-penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BET'T'ER
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. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 ofthe 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. 1 certify toot in the performance of the work for which this permit is issued,I Health&Safety Code,Section 255321 should I store or handle hazardous
shall not employ any person in any manner so as to became subject to the material.Additionally,should 1 use equipment or devices which emir hazardous
of,contnmfnai is as defined by the Bay 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
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CCRTIFICATION Date:06/1312018
I certify that I have read this application and State that the above information Is CONSTRUCTION LENDING AGEN('Y
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 06/13/2018 Professional