B-2018-0795 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0795
10289 PALO VISTA RD CUPERTINO,CA 95014-2714(357 03 059) S M P
CONSTRUCTION&
MAINTENANCE INC
LIVERMORE,CA 94551
OWNER'S NAME:LULLA HIRALAL RAND SULOCHINA li TRUSTEE DATE ISSUED:05/09/2018
OWNER'S PHONE:408-314-3454 PHONE NO:(925)961-9012
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lia#97385
Contractor S M P CONSTRUCTION&MAINTENANCE INC Date 06/30/2018 X BLDG—ELECT—PLUMB
I herebyaffirm that 1 am licensed under the _MECH X RESIDENTIAL—COMMERCIAL
a provisions al'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:
INSTALL(l8)FOUNDATION SUPPORTWORKS MODEL PP288 PUSH
I hereby affirm under penalty of perjury one of the following two declarations: PIERS TO SUPPORT(E)RESIDENCE,
1. 1 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 fthe work for which This permit is issued.
a I have 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 Floor Area: Valuation:$29000.00
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 15701059
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 1S 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 9.1 B. 180 DAYS FROM LAST CALLED INSPECTION.
Signature .tDate 05/09/2018 Issued by:Jasmine Archbold
Data:05/09/2018
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of the RE-ROOFS,
following Vivo reasons: All roofs shall be inspected prior to any roofing material being installed If.roof is
1. I,as owner of the property,or my employees with wuges as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the suuctme is not intended or offered far inspection,
sale(Sec.7044,Business&Professions Cade)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicone
contractors to construct the project(See.7044,Business&Professions Code). Date:05/09/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 permit is issued HAZARDOUS MATERIALS DISCLOSURE
I. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous nmtertots requirements under Chaplet 6.95 of the
Section 3700 of the Labor Corte,for the performance of the work for which this California Health&Safety Code,Scalous 25505,25533,and 25534.I will
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in die performance of the work for which this permit is issued,1 Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
rair contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California,If,a0er making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be dmi ned revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/09/2018 - -
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 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 A1iC111'ITsCT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 05/09/2018 Licensed
Professlonal