B-2018-0029 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0029
21902 OAKVIEW LN CUPERTINO,CA 95014(326 19 105)121900 OAKVIEW LN TITAN GENERAL
CUPERTINO,CA 95014-1146(326 19 105) CONSTRUCTION INC
FREMONT,CA 94539
OWNER'S NAME: DATE ISSUED:05/18/2018
OWNER'S PHONE: PHONE NO:(408)883-8668
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.4948867
Contractor TITAN GENERAL CONSTRUCTION INC Dale 06/30/2018 X BLDG—ELECT—PLUMB
I hereby affirm that 1 nm licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is fn fall force and effect. JOB DESCRIPTION:
CONSTRUCT(N)1 STORY SFD(4044 S.F.);ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations: (443 S.F.);PORCH(50 S.F.);(N)ATTACHED 2ND UNIT(623 S.F.)
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 Code,for the
performance of the work for which this per is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfmwanee of the work far which this
permit is issued. Sq.Ft Floor Area:4667 Valmuion:$800000.00
APPLICANT CERTTFICATION
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'rype:
and state laws relating to building construction,and hereby authorize 326 19 105 R-3(Custom)
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 understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18, 180 DAPS FROM LAST CALLED INSPECTION.
Signature �_.�� Data 06-18-2018 Issued by:Kim Dunbar
Date:05/l8/2018
OWNER-BUH.DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RN:ROOFS
following two reasons: All roofs shall be inspected prior to any roofing material being installed.Ha 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 di'Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05-18-2018
1 hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1, 1 have and will maintain a Certificate of Consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
a 1 have and will maintain Worker's Compensation Invmance,as provided for by I have read tine hazardous materials requirements under Chapter 6.95 of tire
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. matnhdn complhmce with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(a)should I store or handle hazardous
material.Additionally,should 1 use equipment or devices which emit hazm-dous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,atter making this certificate of will maintain compliance with tine 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,.25 33,an('--
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-18-2018
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 stale 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.
Signature Date 05-18-2018 Licensed
Professional