B-2018-0838 CITY OF CUPERTINO BUILDING PERMIT
BU ILDINOADDRESS: CONTRACTOR: PERMIT NO:B-2018-0838
22438 BALUSTROL CT CUPERTINO,CA 95014-3948(356 03 016) MOOMAU PLUMBING
SAN JOSE,CA 95118
OWNER'S NAME: DATE ISSUED:05/15/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lie.#928
Contractor MOOMAU PLUMBING Date 08131/2018 X BLDG_ELECT X PLUMB
I herebyaffirm that I am licensed under the _MECH X RESIDENTIAL_COMMERCIAL
provisions of Chaptm 9(commencing
with Section 7000)a]Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE 40 GAL WATER HEATER(SAME LOCATION)
I hereby affirm under penalty of perjnrp one of the following two declarations:
r. 1 have and will maintain a certificate of consent to self-insure for Workers
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of file Labor Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$2130.00
APPLICANT CERTiRICA'ITON
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 Type:
and stale laws relating to building construction,and hereby authorize 35603 016
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-polnt
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05-15-20108 Issued by:Kim Dunbar
Date:05/15/2018
OWNER-
1 hereby affirm that I am exempt from the Contractor's License Law for ane of the RE-ROOFS:
following two reasons: All root's shall be inspected prior to any roofing material being installed If.roof is
s. I,as owner of the properly,o my employees with wages as their sale installedwithoutfust obtaining an inspection,1 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)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ot'Applieant:
contractors to construct the project(Sm.7044,Business&Professions Code). Date:05-15-20108
1 hereby affirm under penalty of perjury one of the following three dechnations: ALL ROOF COVERINGS'l'O 13E CLASS"A"OR BETTER
v 1 have and will maintain a Certificate o['Consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,to,the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95.['tile
Section 3700 of the Labor Corte,for the performance of[he work For which this California Hwlth&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cope,line Municipal Code,Chapter 9.12 and the
a I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Adrift...fly,should 1 use equipment or devices which emit hazardous
air contaminants as detlned by the Bay Area Air Quality Management District 1
Worker's Compensation laws o£California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the health&SafetyC. -
Label Code,[,,lost forthwith comply with such pnrvisions to this permit shall /
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-15-20108
I certify that I have read this application and slate 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 ARCHITECTA
'S DECLRATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05-15-20108 Professional