B-2018-0863 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0863
20626 SUNRISE DR CUPERTINO,CA 95014-2929(35910038) APLUS GENERAL
CONTRACTORS INC
GARDEN GROVE,CA
92841
OWNER'S NAME: DATE ISSUED:05/18/2018
OWNER'S PHONE: PHONE NO:(714)901-0500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.4763154
Contractor PLUS GENERAL CONTRACTORS INC Date 05/31/2019 Ys BLDG—ELECT_PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X 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:
REPLACE FURNACE SAME LOCATION;NEW AC UNIT
I hereby affirm under penalty of perjury one of the following two declarations: (BACKYARD)
1. I have and will maintain a certificate of consent to self-inswre for Worker's
Compensation,as provided for by Section 3700 o£the Labor Code,fmthe
performance 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 Floor Area: Valuation:$12000.00
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 359 10038
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 ORAdditionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.16. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5-18-2018 Issued by:Kim Dunbar
Date:05/18/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one or tile RE-ROOFS,
following two reasons: All roof's shall be inspected prior to any roofing material being installed.If a of is
1. 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 strutu
cre is not intended Or offered for inspection.
sal,(Scc.7044,Business&PmE,o.m Code)
z l,os owner of the property,am exclusively contracting with licensed Signature of'Applicane
contractors to construct the project(Sec.7044,Business&Pmfcssions Code), Date:5-18-20 19
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labm Code,for the
performance of die work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as In for by I have read the hazardous materials requirements under Chapter 6.95 or the
Section 3700 of the Labor Code,For the perfmmmme of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performnow of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should 1 store ar handle hazardous
shall not employ any person in any manner se as to become subject to the material.Additionally,should I use equipment or devices which emit hnznrdous
air contaminants as donned by the Bay Area Air Quality Management District I
Worker's Compensation laws orCalifornia.If,after making this certlfwate of will maintain complbutec 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 Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CWFIFICATION Data:5-18-2018
I 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 ARCHITECT'S DECLARAPION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 5-18-2018 professional