B-2018-0507 (3) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0507
1495 ASTER LN CUPERTINO,CA 95014-5217(366 24 005) GLOBAL BAY
CONSTRUCTION INC
SAN JOSE,CA 95132
OWNER'S NAME: DATE ISSUED:0312612018
OWNER'S PHONE: PHONE
LICENSED R T R' DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#995935
Contractor GLOBAL BAY CONSTRUCTION INC Date 08131/2018 X BLDG_ELECT_PLUMB
1 herebyaffirm that I am licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMODEL KITCHEN LIKE FOR LIKE-(165 SF)
I hereby affirm under penalty of perJury one of the following two dedaratlans;
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,fmthe
performance of the 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: Valuation:$1400.00
APPLICANT CERTIFICATION
I certify that I have readthls application and slate 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 366 24 005
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 CupertinoMunicipal Code,Section 9.1 B. 180 DAYS FROM LAST CALLED INSPECTION.
Signature — 'lam Date 03/26/2018 Issued by:Jasmine Archbold
Date:03/26/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Lav for one of theRE-ROOFS•
following two reasons: -All roofs shall be inspected prior to uny roofing material being installed.If a roof is
1. 1,as owner of the property,or my employees with wages as their eule installed without fust obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or oHbred for inspection.
sale(See.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signahue of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Cade). Date:03/26/2018-
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS W'OR BETTER
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
pen f nnance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 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 25534.1 will
permit is issued. maintain 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(a)should I store or handle hazardmts
shall not employ any person in any manner so re to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
air
contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain cmnplienee with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized
APPLICANT CERTIFICATION CERTIFICATION Date:03/26/2018
1 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 03/26!2018 Licensed
Professional