D-2018-0015 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0015
10740 RANDY LN CUPERTINO,CA 95014-2055(316 02 073) T Q CONSTRUCTIONS
SAN JOSE,CA 95133
OWNER'S NAME: DATE ISSUED;06/22/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie#1447728
Contractor T Q CONSTRUCTIONS Date 09/30/2019 —BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH XX 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:
REMOVE EXISTING HOME WITH ATTACHED GARAGE(2082 SF);
I hereby affirm under penalty of perjury one of the following two declarations: SHED(120 SF)
r. I have and will maintain a certificate o£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.
i. 1 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 Fluor Area: Valuation:$15000.00
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 Numbei: Occupancy Type:
and stale laws relating to building construction,and hereby authorize 31602 073
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 regulationsWterte,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/221201 B Issued by:Jasmine Archbold
� Date:06/22/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS•
following two reasons: All roof's shall be inspected prior to any rooting material being installed.11 a roof is
1. 1,as ownerofthe 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 Sigoutue of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:06/22/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
u 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,m 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 1 have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which[his "Boamta 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
s. I certify that in the performance of the work for which this permit is issaed,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
sir 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 compliance 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 25 05 2 533 and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall �
be deemed revoked, Owner or authorized age,,- /�!
APPLICANT CERTIFICATION Date:013/2D2018
I certify that I have read this application and state that the above information is CONST I LE D '
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 9.1 B. I understand my plans shall be used as public records.
Signature Date 06/22/2018 Licensed
Professional