B-2018-0613 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0613
22557 CRISTO REY DR CUPERTINO,CA 95014(342 63 002) STEPHEN CIARI
PLUMBING AND
HEATING INC
SAN JOSE,CA 95126
OWNER'S NAME; DATE ISSUED;04/12/2018
OWNER'S PHONE: PRONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 036 Lie.#828351
Contractor STEPHEN CIARI PLUMBING AND HEATING INC Date 12/31/2019 X BLDG—ELECT—PLUMB
1 hereby affirm that I nm licensed tinder the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Cade and that my
license is in full force and effect. JOB DESCRIPTION:
INSTALL GAS LINE(l00 LF)
I hereby affirm under penalty of perjury one of the following two declarations:
r. Ihave and will maintain a certificate of consent to self-inane for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued.
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; Valuottun:$8000.00
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'fype:
and state laws relating to building construction,and hereby authorize 342 63 002
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 per the Cupertino Muniip Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION,
Signature Date 04-12-2018 Issued by:Kim Dunbar
Date:04/12/2018
OWNER-BUILDFR DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following to,.reasons: - All roofs shall be inspected prim to any roofing material being installed If a roof is
r. 1,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 1,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicauu
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04-12-2018
I hereby affirm under penalty of perjury one ofthe following three declarations; ALL ROOF COVERINGS TO BF,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 Code,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
1. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. m aintain compllame,with the Cupertino Municipal Code,Chapter 9.12 and tine
3. 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
-shat]not employ any person in any manner so as to become subject to thematerial,Additionally,should 1 use equipment or devices which emit hazardous
nlr conhiminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,alter making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety Code,9pctions 25505 25 and 25534,
Labor Code,I must forthwith cauuply with such provisions at this permit shall /Vg/IAIIQI� �.
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:04-12-2018
I certify that I have read this application and state that the above Information is CONSTRUCTION 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 VICHI'I'EC'1M DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 04-12-2018 Licensed
Professional