B-2018-0829 CITY OF CUPERTINO BUILDING PERMIT
BU ILDINGADDRESS: CONTRACTOR: PERNIIT NO:B-2018-0829
22661 QUEENS OAK CT CUPERTINO,CA 95014-5616(342 32 063) STREET PLUMBING
AND ROOTER
SAN JOSE,CA 95128
OWNER'SNAME: DATE ISSUED:05/15/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Llc.#582217
Contractor STREET PLUMBING AND ROOTER Date 12/31/2019 X BLDG ELECT X PLUMB
I 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:
REPLACE 40 GAL WATER HEATER(SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
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£or which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as to 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:$1600.00
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 342 32 063
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 regal Iti per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05-15-2018 Issued by:Kim Dunbar
Date:05/15/2018
W E - 'CLARATI N
1 hereby aftirnm that I out exempt from the Contractor's License Law to,.one of the RE-HOOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If.reel'is
1. 1,as owner of the property,or my employees with wages as their sole fiamllicd without first obtaining an inspcothoi,I agree to remove all new materials too-
compensation,
orcompensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sce.7044,Business&Professions Cade)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code). Date:05-15-2018
1 hereby affirm under penalty of insojury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERn. I 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 of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided far by I have read the hazardous materials requtremmus under Chapter 6.95 of the
Section 3700 ofthe 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. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work Health&Safety Code,Section 25532(x)should I store or handle hazardous for which this permit is issued,I material.Additionally,should I use e
shall not employ any person in any manner so as to become subject to the Y equipment r Quality
which emit hazardous
I
air confirm neo compliance
ance w h the Bay Area Air Quality Management District 1
Worker's Compensation laws of California, If,after making This certificate of will mahrtain compliance with the Cupertino Mnnfeipnl Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Sol ty
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-15-2018
I certify that I have read this application and state that the above information Is CO STRU AGENcorrect.I agree to comply with all city and county ordinances and state laws hereby affirm that there Is a construcion 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,casts,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 ARCHI'TECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 05-15-2018 Professional