B-2018-0595 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0595
20100 LAS ONDAS CT CUPERTINO,CA 95014-3106(369 30 039) DE ANZA BUILDERS
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:04/11/2018
OWNER'S PHONE: PRONE NO:(408)865-0222
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#943227
Contractor DE ANZA BUILDERS Date 02/29/2020 X BLDG—ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —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:
REMODEL(2)BATHROOMS(100 SF)
I hereby affirm tinder penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of emrsent to self-insure For Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
z perr
formance of the work for which this pat is issued.
1 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
parmit is issued, Sq.Ft Floor Area: Valuation:$20000,00
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: Occup iney Type:
and state laws relating to building construction,and hereby authorize 369 30039
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 appli a t understands and will comply with all non-point
source regulations p r th Cupertino and
Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 04/11/2018 Issued by:Jasmine Archbold
Date:Q4/11/2018
OWNER-BUILDER LARAT
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
Following two reasons: All roof's shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my 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.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/11/2018
1 hereby of irm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 have and will maintain a Certificate of Consent to self-insum lot 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. 1 have and will maintain Worker's Compensation Insurance,as provided far by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for die performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. nrahnain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ i In an to material.Additionally,should I use egniym• devices which emit hazardous
p y m y person y mzurner so as become subject to the air contaminants as defined by the 13sy Are Air utility Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertin Man cipnl Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation to of the the Health&Safety Code,Section 255 5,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed tevaked, Owner or authorized agent:
APPLICANT CERTIFICA'11019 Date:04/11/2018
1 certify that I have read this application and state that the above Information Is CONST LENDI\NIG 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 ARCIIITECT'S DECLARATTON
Code,Section 9.18. understand my plans shall be used as public records.
Licensed
Signature Date 04/11/2018 Professional