B-2018-1063 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1063
20298 CLAY ST CUPERTINO,CA 95014-4401(369 39 019) MARCELO ELECTRIC
UNION CITY,CA 94587
OWNER'SNAME; DATE ISSUED:06/25/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C 1 Lt.,#915061
Contractor MARCELO ELECTRIC Date 04/30/2020 X BLDG X 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 fall force and effect. JOB DESCRIPTION:
UPGRADE PANEL(200 AMP)-SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
n 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.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Arco: Valuation;$2800.00
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 pPN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 39 019
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 Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6125H8 Issued by:Jasmine Archbold
Date:06/25/2018
OWNERBUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law far one of the RE-ROOFS:
fallowing two reasons: All roof's shall be inspected prior to any roofing material being installed.If'a roof is
1. 1,as Owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do the work,and the structure is not intended of offered for inspection.
sale(Scc.7044,Business&Professions Code)
z. 1,as owner ofthe property,am exclusively contracting with 1(ecnsed Signature ofApplieant
contractors to construct the project(Sce.7044,Business&Professions Code). Date:6/25/18
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 hovered will maintain a Certificate of Consent to self-insure for Worker's
COmpeusivamn 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 provider)for by I have read Bre hazardous materials requirements under Chapter 6.95 iir the
Section 3700 of the Labor Cede,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,l Health&Safety Cade,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner se as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
air contnminnnts as defined by the Bay Arca Air Quality Management District 1
Worker's Compensation laws of California.If,after making this cenificete of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l became subject to the Worker's Compensation provisions of the the Health&Safety Cede,Sections 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
APPLICANT CERTIFICATION Data:6/25/16
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 ail non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used es public records.
Licensed
Signature Data W25/18 professional