D-2018-0033 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0033
22462 WALNUT CIR S APT B CUPERTINO,CA(35703034) A-I HAULING
CAMPBELL,CA 95009
OWNER'S NAME: DATE ISSUED:05/21/2018
OWNER'S PHONE: PHONE NO:(408)978-2903
LICENSEDCONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_12 Lic.#618640
Contractor A-1 HAULING Date 04/30/2019 —BLDG—ELECT_PLUMB
I herebynffirm that Ism licensed under the .visions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
pr p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
DEMO POOL-(372 SF)-FOR LANDSCAPE PURPOSES ONLY
I hereby affirm under penalty of perjury one of the following five declarations:
1. 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 Cade,for the
per of the work for which this permit is issued.
z 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 Fluor Area: Valuation:$7500.00
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: Occupancy Type:
and state laws relating to building construction,and hereby authorize 35703 034
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 IIP 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 Mu lei al Oo ie,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signet / Date 05/21/2018 Issued by:Jasmine Archbold
Date:05/21/2018
ER-¢ 1 DE
I hereby af¢rm that I wn exempt from the Contractor's License Law for one of the RE-ROOFS•
£ollowfng two 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 employee with wages se their sole installed without First obtaining an nspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(See.7044,Business&Professions Code)
2. 1,as owner ofthe property,am exclusively contracting with licensed Signoture.&Applicant:
contractors to construct the project(Scc.7044,Business&Professions Coda). Date:05/21/2018
1 hereby affirm mlder penalty of'pe,-j.,y one at the following three deelmratk nsi ALL 1200F COVERINGS TO¢E CLASS"A"OR BETTER1. 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
i. 1 have and will maintain Worker's Compensation Insurance,as provided for by I futecreml the hazardous materials requirements wider 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
s. 1 certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Section 25532(x)should I store or handle Imzardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
atr contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this ceruficme of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,255,p-an25534.
Labor Code,I must forthwith comply with such provisions or this permit shall �-
be deemed revoked, Owner or authorized ageftt:
APPLICANT CERTIFICATION Date:05!21/2016
I certify that I have read this application and state that the above Information Is CON TRU I TION I Di C
correct.1 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.
SignatureDate 05!2112018 Licensed
Professional