B-2018-1057 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1057
20967 FAIRWOODS CTCUPERTINO,CA 95014-4200(359 13 114) AVILA'S
REMODELING AND
CONSTRUCTION
SAN JOSE,CA 95156
OWNER'SNAME: DATE ISSUED:06/25/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#422635
Contractor AVILA'S REMODELING AND CONSTRUCTION Date 05/31/2020 X BLDG ELECT_PLUMB
I hereby affirm that 1 am licensed ander 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:HALLWAY BATHROOM(72 SF)AND
I hereby affirm under penalty of perjury one of the following two declarations: MASTER BATHROOM(213 SF)-TOTAL(285 SF)
r. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
�4Sectimr 3700 ofthe Labor Code,for the performance of the work for which this
permit is issued. Sq,Ft Floor Area: Valuation:$60880.00
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 Type:
and state laws relating to building construction,and hereby authorize 359 13 114
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 WORT{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 G nicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06-25-2018 Issued by:Kim Dunbar
Date:06/25/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt Brom the Contractor's License Law in one of the RE-ROOFS:
following two reasons; All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner ofthe 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.
set.(Sec.7044,Business&Professions Cade)
z. 1,as Owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sce.7044,Business&Professions Code). Date:06-25-2018
1 hereby affirm order penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have and will maintain a Certificate of Consent to self-insure far 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. I 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 Cnlifornta Health&Safety Code,Sections 25505,25533,and 25534.1:will
permit is issued. tri aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance ofthe work for which this permit is issued,I Health&Safely Cade,Section 25532(n)should 1 store or handle hazardous
shall not em annex so as m become subject to the material.Additlonally,should I use equipment or devices which emit hazardous
to an
employ y person in any m 1 air contaminants as dented by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will mnfntain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety Code,Sections 25505,255 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
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,Clv 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.
Licensed
Signature Date 06-25-2018 Professional