B-2018-0904 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0904
10538 RED FIR CT CUPERTINO,CA 95014-4246(359 05 009) COMPLETED
CONCEPTS
SAN JOSE,CA 95116
OWNER'S NAME: DATE ISSUED:05/25/2018
OWNER'S PHONE: PHONE NO:(408)655-3881
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class SOLAR Do.#817623
Contractor COMPLETED CONCEPTS Date 02/28/2019 X BLDG X ELECT_PLUMB
1 herebyaffirm that 1 am licensed tinder the visions of Chapter 9 —MECH X RESIDENTIAL—COMMERCIAL
n pro p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is fn full force and effect. JOB DESCRIPTION:
REWIRE(E)TOWNHOUSE;REPLACE ELECTRICAL PANEL(100
I hereby affirm under penalty of perjury one of the following two declarations: AMP);ADD SUB-PANEL(100 AMP).
i. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 e£the Labor Code,for the
performance of the work for 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.IT Floor Area: Valuation:$40000.00
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 APN Number: Oc mpaucy Type:
and slate laws relating to building construction,and hereby authorize 35905 009
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 nderstands and will comply with all non-point
source regulations per!0 Cupertino Municipal Code,Snectil 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature - Date 5.2518 Issued by:SEAN HATCH
Date:05/25/2018
O NER-II Il X12 DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law I'or one ol'the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofng material being installed.Its roof is
1. I,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,I agree to renmve all new materials for
compensation,will do the work,add the structure is not intended or offered for inspection.
sale Business&Professions Cade)
z. f,as owner of the property,am exclusively contracting with licensed Signature ofApplicanl:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:5.25.18
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
u 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
perfurnnanee of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,os provided for by I],act read the hazm dour materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Cod.,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issuedm aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as delined by the Bay Ar on Air Quality Management District 1
Wurker's Compensation laws of California,If,after making this certificate of will maintain compliance with the Cupertino Mumfefpal Code,Chapter 9.12 and
exensptieu,I become subject to the Worker's Compensation provisieas of[he fie Health&Safety Code,Sdrfiofd 25505,25533,and 25534.
Labor Cede,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agen
APPLICANT CERTIFICATION Data:5.25.18
I certify that I have read this application and slate that the above information is OC'fl N LE Df N'CY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co Mructi,n 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 harmlessthe 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 MunicipalAItCHI.PVCT'S DECLARKNON
Code,Section 9.18. understand my plans shall be used as public records.
Licensed
Signature Date 5 25.18 Professional