B-2018-0806 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0806
1100 ELMSFORD DR CUPERTINO,CA 95014-4909(362 06 004) THE HONEST
PLUMBER
BAKERSFIELD,CA
93308
OWNER'SNAME: DATE ISSUED:05/10/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_36 Lic.dt91a339
Contractor THE HONEST PLUMBER Date 0713112018 X BLDG—ELECT X PLUMB
1 hereby nftirm that 1 am licensed under the provisions of Chapter 9(commencing —
MECH X RESIDENTIAL_COMMERCIAL
with Section 1000)of Division 3 ofthe Business&Professions Code and that my
license is in full farce and effect. JOB DESCRIPTION:
REPLACE(40)GAL WATER HEATER-GARAGE
I hereby affirm under penalty of perjury one of the following two declm•ntions:
r 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 ofthe work for which this permit is issued.
z I have and will maintain Worker's Compensation Insurance,as provided for by
+. octtiou 3700 ofthe Labor Code,for the performance of the work for which this
, is issued. Sq.Ft Floor Area: Valuation:$1200.00
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: Occupancy Type:
and state laws relating to building construction,and hereby authorize 36206 004
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 regulati s pe 9e Cupertino Municipal Code,Section 9,18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature /^ pate 05/10/2018 Issued by;Jasmine Archbold
Date:05/10/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following hvo reasons: All roofs shall be inspected prior to any roofing material being instal led.If e roof is
r. I,as owner of the property,or my employees will,wages as their We installed without first obtaining so inspection,I agree to remove all new materials for
ompensatimi will do the work,and the structure is not intended or offered for inspection,
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicane
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/10/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided fm'by I have read the hazm dons,muerlals requirements under Chapter 6.95 of the
Section 3700 of the Labor Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.twill
permit is issued. m aintain compliance,fth the Cupertino Municipal Code,Chapter 9.12 mrd the
a. I certify that in the performance of the work for which this permit is issued,I Health&Su cty Code,Section 25532(x)should I stare or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Addittmmlly,should 1 use equipment or devices which emit hazardous
nfr contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain complimrce with the Cnpertlno Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code cell 2550 55 3, nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revolted, Owner or authorized agent:
APPLICANT CERTIFICATION Date:05110!2018
I certify that I have read this application and state that the above information is CONSTRU '10 ENDING AGE Y
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.)
toenter 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,
s costs,and expenses which may accrue against said City in Lender's Addres
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.
SignatureData 05!10!2018 Licesed
Profenssional