B-2018-0798 CITY OF CUPERTINO BUILDING PERMIT
BU ILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-0798
10337 MILLER AVE CUPERTINO,CA 95014(369 W 034) HOME DEPOT U 5 A
INC
ATLANTA,GA 30339
OWNER'S NAME: DATE ISSUED:05/09/2018
OWNER'S PHONE: PRONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Uc.#602331
Contractor HOME DEPOT U S A INC Date 09/30/2018 X BLDG_ELECT_PLUMB
I herebyform that I am licensed under the _MEC14 X RESIDENTIAL_COMMERCIAL
a provisions nl'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:
MINOR BATH REMODEL-1NSTALLACRYLIC TUB LINER AND
1 hereby affirm under penalty of perjury one of the following two declarations: WALL SYSTEM;INSTALL NEW SHOWER VALVE
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 Cade,for the
performance the work for which this permit is issued. have and willll maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perma
fornce of the work for which this
permit is issued, Sq.Et Floor Area: Vnlwhtfmr:$6794.00
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 stale laws relating to building construction,and hereby authorize 369 14 034
representatives of this city to enter upon the above mentioned properly 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 I nicipal Code.Section 9.18, 180 DAYS FROM LAST CALLED INSPECTI
Additionally,the applicant understands and will comply with all non-point
source regulations per the CuperON.
Signature Date 05-09-2018 Issued by;Kim Dunbar
Date:05/09/2018
OWNER-B 1
1 hereby affirm Hut I um axempt from the Compactor's License Lav 1'o,-one of theRE-ROOFS:
following five reasons: All of,shall be inspected prior to any rooting material being installed.He roof is
n. I,as owner of the property,or my employees with wages as their sole insudled without first obtaining an inspection,I agree to remove all new nuou his for
ompensstioo,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Cade)
2. 1,as owner of the property,am exclusively contracting with keensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code). Date:05-09-2018
1 hereby affirm under penalty tdperjury one at the following three declarations: ALL ROOF COVCRINGS'1'O BE CLASS"A"OR BETTER
t. 1 have and will maintain a Certifieale 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 requironents under Chapter 6.95 of the
Section 3700 ofthe Labor Corte,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
m
s. 1 certify that in the perfornnee of the work for which this permit is issued,I n Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ n to material.Additionally,should 1 use equipment or devices which emit hazardous
p y any person in any manner so as become subject to the air contnmimmts 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 compliance with the Cupertino Municipal Code,Chapter 9,12 and
exemption,I became subject to the Worker's Compensation pmvismas of the the Health&Safety Cade,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CEIi'I'1 FICATIpIN Data:05-09-2018
I certify that have read this application and state that the above information Is C ENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that(Fare 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
Cade,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05-09-2018 Licensed
Professional