B-2018-1087 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1087
10591 S BLANEY AVE CUPERTINO,CA 95014-4542(369 33 004) NEW MILLENNIUM
ELECTRIC
LOS ALTOS,CA 94022-
2912
OWNER'SNAME: DATE ISSUED:06/26/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lie.#829299
Contractor NEW MILLENNIUM ELECTRIC Date 1 213112 01 9 X BLDG X ELECT—PLUMB
1 herebyform that I am licensed under the visions of Cha ter 9 _MECH X RESIDENTIAL_COMMERCIAL
a pro p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
Harrow is in fall farce and effect. JOB DESCRIPTION:
UPGRADE PANEL(200 AMP)-SAME LOCATION
1 hereby affirm under penalty of perjury one of the following two declarations:
r. 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
performance of the work for which this permit is issued.
z. 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
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 36933 004
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 will comply with all non-point
source regulations per the cu •'o Munici al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature 86/28/2018 Issued by:Jasmine Archbold
Date:06/28/2018
O R LARATIO ----`
I hereby affirm that I nm exempt from the Contractor's License Law for one of the RE-ROOFS:
following hvo 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 inteuded or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner ofthe property,ams exclusively contracting with licensed Signature of Applicane
contractors to construct the project(See.7044,Business&Professions Code). Data:06/28/2018
1 hereby affirm under penalty of perjury one ofthe following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have slid 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. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as provided for by I leave read the hazmdous materials requirements under Chapter 6.95 ofthe
Section 3700 ofthe Labor Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain conrplbmce with the Cupertino Nlunicipai Code,Chapter 9.12 and the
s. I 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
shall not employ any person in any manner s0 as to become subject to the material.Additionally,should I use equipment or device
s which emit hazardous
air contaminants as defined by the Bay Area Air Qua' anngement District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Caperti nicipai Code; hepta•9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe theHenItli&SafiatyCecSSe mis25505,25533,tand 5534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ,Owner or au -------
thorized agent:
APPLICANT CERTIFICATION Date:06/28/2018
I certify that I have read this application and state that the above Information Is CONSTRUCTION LE , CV
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a constca ion 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
Cade,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 06/28/2018 Licensed
Profa atonal