B-2018-0451 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0451
10466 MILLER AVE CUPERTINO,CA 95014-3428(375 05 037) U S GREEN BUILDERS
INC
NEWPORT BEACH,CA
92660
OWNER'S NAME: DATE ISSUED:05/16/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lia#991063
Contractor U S GREEN BUILDERS INC Date 03/31/2020 X BLDG—ELECT—PLUMB
1 hereby affirm that I am 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 in full force and effect. JOB DESCRIPTION:
CONSTRUCT AN.ATTACHED PREFABRICATED COVERED PATIO
I hereby affirm under penalty of perjury one of the following ten declarations: (235 SF).
1. f 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 was k for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 urine Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation$3000.00
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: Occup om y Type:
and state laws relating to building construction,and hereby authorize 37505 037
representatives of this city to nt r upon the above mentioned property for
inspection purposes.(We gra to save indemnify and keep harmless the
City of Gupertinoagainsyiabili:i s,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may,accrue against s City i consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the appI ant un ersI it and will comply with all non-point
source regulations er t upedino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 05-16-2018 Issued by:ICim Dw 1.
Date:05/16/2018
OWNER- 2 C A
I hereby affirm that 1 am exempt finin the Contractor's License Law fur one or the RE-ROOFS•
following tao reasons: All roofs shall be inspected prior to any roofing material Mug installed.If a roof is
e. I,as owner of the property,o my employees with wages as their sale installed without first obtaining an inspection,I agree to remove all aew materials for
compensation,will do the work,and die structure is not intended or offered fiinspection.
sale(See.7044,Business&Professions Code)
i. 1,as owner ofthe property,am xclusively contracting with licensed Signature ofApplicaut:
contractors to construct the project(Sce,7044,Business&Professions Code). Date:05-16-2018
I hereby affirm under penalty of perjury are of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have and will maintain a Certificate of Consent to sell'-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
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the haze dons materials requirements under Chapter 6.95 of the
Scotiou 3700 of the Labor Code,for the pe,fmmance of the work for which this Califo•ata Health&Safety Code,Settle as 25505,25533,and 25534.I will
permit is issued. maintain compllance with the Cape fine Municipal Code,Chapter 9.12 and the
a I certify that in the performance of the work far which this permit is issued,I health&Safety Coda,Section 25532(a)should 1 sfoyyeTi handle hazardous
shall mol cm ilo son in an manner so as m become subject to the mnterinl.Additionally,should 1 use gul
�iy� hieh emit hazardous
1 y any per y m 1 air contaminnts as defined by tine Bpp4 ty Management District I
Worker's Compensation laws ofCalifornia.IC,after making this certificate of will maintain compliance whit the Cipal Code,Chapfer9.12 and
exemption,I become subject to the Worker's Compensation provisions of the flee Health&Safety Code ,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT'CERTIFICATION Data:05-16-2018
I certify that I have read this application and elate that the above information is CONSTRDCTION-IM11DING 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 DECLARATION
code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 05-16-2018
Professional