B-2018-0536 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0536
18850 BARNHART AVE CUPERTINO,CA 95014-3602(375 33 015) CNP CONSTRUCTION
INCORPORATION
SAN JOSE,CA 95130
OWNER'S NAME: DATE ISSUED:04/02/2018
OWNER'S PHONE: PHONE NO:(408)726-2956
LICENSED DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.#1011$@2
Contractor CNE CONSTRUCTION INCORPORATION Date 03/31/2020 X BLDG X ELECT_PLUMB
I hereby at'tirm that I am licensed under fhe 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 fail force and effect. JOB DESCRIPTION:
TEMP POWER POLE-(100 AMP)
I hereby affirm under penalty of perj my one of the following two declaratimou
i. 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.
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:$700.00
APPLICANT CERTIFICATION
I certify that I have read this appllcallon and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occuponcy type:
and slate laws relating to building construction,and hereby authorize 375 33 015
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 applic derstands and will comply with all non-point
source regul�Inas pbe upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 04-02-2018 Issued by:Kim Dunbar
Date:04/02/2018
O NER-BUI DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law tor one of theRE-ROOFS:
following two=: All roofs shall be inspected prior to say roofing material being installed.If a roof is
r. 1,as ownerofthe property,or my employees with wages as their sole installed without first obtaining au 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(Scc.7044,Business&Profcssimis Code)
z. f,as owner ofthe properly,am exclusively contracting with licensed Signature of Applicant
contractors to constmct the project(Sec.7044,Business&Professions Cade). Date:04-02-2018
1 haroby affirm under penalty of perjury are of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERi. I have and will maintain a Certificate of Consent m self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for die
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements wider Chapter 6.95 of the
Section 3700 of the Labor Code,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
Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. 1 certify that in the y paramnn of the work for which this permit is issued,] material.Addttionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the contaminantsair as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of wLl maintain compliance with the Cupertit Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cu a io 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
API']ICANT CERTIFICATION Date:04-02-2018
I certify that I have read this application and state that the above information is C N TZJCA110N LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there istw6onstruction 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 ARCHI'TECT'S DECLARATION
Code,Section 9.18. - 1 understand my plans shall be used as public records.
Signature Date 04-02-2018 Licensed
Professional