B-2018-0588 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRAC'T'OR: PERMIT NO:B-2018-0588
11850 UPLAND WAY CUPERTINO,CA 95014-5106(366 03 025) ROOTER HERO
PLUMBING INC
MISSION HILLS,CA
91346
OWNER'SNAME: DATE ISSUED;04/10/2018
OWNER'S PHONE: PHONE NO:(888)929-4376
LICENSED BUILDING PERMIT INFO:
License Class C36 Lip.#9 301
Contractor ROOTER HERO PLUMBING INC Date 0 5/3112 01 8 X BLDG_ELECT X PLUMB
hereby affirm that 1 am licensed tinder the previsions at Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fit[[force and effect. JOB DESCRIPTION:
SEWER LINE REPAIR;INSTALL PROPERTY LINE CLEAN OUT
I hereby affirm under penalty of perjury one of the following two declarations:
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 of the work for which this permit is issued.
Lyrl—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:$9000.00
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 authgrize 36603 025
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 regulations r the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature
Data 04-10-2018 Issued by:Kim Dunbar
Data:04/10/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt tram the Contractor's License Law for one of the RE-ROOTS:
following two reasons: All roofs shall be inspected prior to any rooting material being installed.If a roof is
r. 1,as owner,of the property,or my employees with wages as their .to 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.
sale(Sec.7044,Business&Professions Cade)
z. L as owner ofthe property,am xclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04-10-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOK COVERINGS TO BE CLASS"A"OR BETTOR
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 of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as In for by f have read the luizardoes materials requirements under Chapter 6.95 ol'the
Section 3700 of die Labor Code,for the per£ormauce 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
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 sture or handle hazardous
shall not employ any person in any manner sees to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
in euntaminants as defined by the Bay At en Air Quality Management District I
Worker's Compensation laws of California. II',alter making this certificate of wif maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,1 become subject to the Worker's Compensation previsions of the the He I I&Sat'ety Codc,Sc I as 5505,2553 mrd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:04-10-2018
1 certify that I have read this application and state that the above information is CONS" U TION 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature ❑ate 04-10-2018 Licensed
Professional