B-2018-0859 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS; CONTRACTOR: PERMIT NO:B-2018-0859
10970 MARIA ROSA WAY CUPERTINO,CA 95014-4720(356 18 005) HOME DEPOT U S A
INC
ATLANTA,GA 30339
OWNER'S NAME: DATE ISSUED:05/18/2018
OWNER'S PHONE: PHONE NO:(770)433-8211
LICENSED CONTRAC'TOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#602331
Contractor HOME DEPOT U S A INC Date 0913012018 X BLDG_ELECT_PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE SIDING (1600 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of ec nscut to scl&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.
Ihave 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:$26060.00
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: Occupnmey Type:
and state laws relating to building construction,and hereby authorize 356 18 005
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 WORI{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 9.16. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date Issued by:Kim Dunbar
Date:05/18/2018
U2-B r TI
I hereby affirm tI am exempt from the Contractor's License Law for one at line RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roc ring material being installed.If a roof is
r. I,as owner of the properly,or my employees With wages as their sole installed without first obtaining,oat inspection,I agree to remove all new materials for
compensation,will do the work,and the strucnve is not intended or offered for inspection.
sal,(Sec.7044,Business&Professions Code)
2. 1,as owner of the properly,am exclusively contracting with licensed Signature ufApplicanr
contractors to cotsumet the project(Sec.7044,Husiness&Professions Code). Dale;
1 hereby affirm trader 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
performance of the work for which this permit is imncd. HAZARDOUS MATERIALS DISCLOSURE
1. 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 of the Labor Code,for the performance of the work far which this California Health&Safety Code,Sections 25505,25533,and 25534.twill
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Section 25532(0)should I store or handle hazardous
shell not employ may person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,alter making this certificate of will maintain camplimlea with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revaked. Owner or authorized agent:_
APPLICANT CERTIFICATION Date:
I certify that I have read this application and slate that the above information Is C " ' IDT G A
CGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co action 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 DECLAHA'1'ION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data Professional