B-2018-0800 CITY OF CUPERTINO BUILDING PERMIT
BU I LDINO ADDRESS: CONTRACTOR: PFRMI'1'NO:B-2018-0800
20255 NORTHGLEN SQ CUPERTINO,CA 95014-0517(316 39 009) HOME DEPOT U S A
INC
ATLANTA,GA 30339
OWNER'S NAME: DATE ISSUED:05/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#602331
Contractor HOME DEPOT U S A INC Date 99/30/2018 X BLDG ELECT PLUMB
1 hereby nfiL•m that I em licensed nndea the previsions of Chapter 9(commencing MECPI X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall farce and effect. JOB DESCRIPTION:
REPLACE(1)WINDOW(3)PATIO DOORS LIKE FOR LIKE TO MEET
1 hereby affirm under penalty of perjury one of the following two declarations: EGRESS
t. 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 walk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Label Code,for the performance of tile work for which this
permit is issued. Sq.Ft Floor Area: Vnhration:$5972.00
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 316 39 009
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 WORI{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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ate 05-09-2018 Issued by:Kim Dunbar
Date:05/09/20]8
OWNER-BUILDER D, R
I hereby afire that I am exempt from the Contractor's License Law 1'or one hf tine RE-ROOFS:
following five re sans: All roofs shall be inspected prior to any roofing material being installed,If a of is
r. I,as owner ofthe property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new,are,lots for
ompcnsatimn,will do the work,and the structure is not intended or offered for ospection.
sale(Sec.7044,Business&Professions Code)
i. 1,aswalor of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date;05-09-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGSTO BE CLASS"A"Oil BETTER
r. 1 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
z. I have and will maintain Worker's Compensation Instuance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the not of the work for which this California Health&Safety Cade,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I. I certify that in the performance of the work for which this permit ie issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ a material.Additionally,should I use equipment or devices which emit hazardous
p y a yion law in anymann s.so as le become subject to the r contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.II',alter making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-09-2018
I certify that I have read this application and slate that the above information is CONST O ANCY
correct.I agree to comply will)all city and county ordinances and state laws I hereby affirm that there is a constructigilleading 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 properly for inspectlon 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 ARCItft'ECT S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 05-09-2018
Professional