B-2018-0623 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0623
10590 CASTINE AVE CUPERTINO,CA 950144311(326 44 044) H B CONSTRUCTION
SERVICES INC
CASTRO VALLEY,CA
94546
OWNER'S NAME: DATE ISSUED:04/16/2018
OWNER'S PHONE: PHONE NO:(5 10)388-9899
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#1001862
Contractor H B CONSTRUCTION SERVICES INC Date 03/31/2019 X BLDG ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(cora Ging —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:
FIRST FLOOR BATH REMODEL(1);SECOND FLOOR BATH
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL(2)(218 SF)
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 Cade,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as in for by
Scenen 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Fla.r Are.: Valuation:$29000.00
APPLICANT CERTIFICATION
I certify that 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 12644044
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 regul3 ns per the Cupertino Municipal Code,.Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 01-16-2018 Issued by:Kim Dunbar
Date:04/16/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law to,-one of the RE-ROOFS:
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
n. I,as owner of the property,army employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not Intended or offered for inspection.
sato(Sce.7044,Business&Professions Code)
z 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:01-16-2018
I hereby affirm under penalty of po•j U one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 Cade,for the
performance of the wok for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 ofthe
Section 3700 of-the Labor Code,for the performance of the work for which this California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance ofthe work for which this permit is issued,I Health&Safety Corte,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
air contaminants as dented 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 become subject to the Worker's Compensation provisions of the the Health&Safety Codis 255 5 3,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:01-16-2018
I certify that I have read this application and state that the above information is CONSTRUCT ON 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,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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 01-16-2018 Licensed
Professional