B-2018-1080 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1080
18580 BARNHART AVE CUPERTINO,CA 95014-3602(375 33 012) W C EXTERIOR CO
WEST SACRAMENTO,
CA 95691
OWNER'SNAME: DATE ISSUED:06/27/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#948508
Contractor W C EXTERIOR CO Date 06/30/2020 x BLDG—ELECT—PLUMB
I hat,lby affirm that I am licensed order the Previsions of Chapter 9(commercial;g —MECH XRESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect, JOB DESCRIPTION:
INSTALL PATIO COVER(378 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate ofconsent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
`
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$12554.00
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 375 33 012
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 Cupertin gainst liabilities,judgments,costs,and expenses whichPERMIT EXPIRES IF WORK IS NOT STARTED
may accrue ag In said 'ty in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,th a Ilcant nderstands and will comply with all non-point
source regula Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur bate 2-27-2018 Issued by:Kim Dunbm
Date:06/27/2018
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 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 wore,and the shuehue is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature o£ApplicanC
contractors to construct the project(Sec.7044,Business&Professions Code). Use:2-27-2018
I hereby affirm under penalty of perjury one of the fallowing three declarations: - ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-insme for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,Por the
Pei formance 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 matin lots requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performamee of the work for which this California Health&Safety Cade,Sections 25505,25533,and 25534,I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work far which this permit is issued,I r Health&Safety Cade,Section 25532(a)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
air contaminants as defined by the B -Ai Quality Mmtagorent Diatrfet I
Worker's Compensation laws of California.If,after making this certificate of will rnintain compliance with the C .inn nicipal Code,Chapter 9,12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICAN'1'CER't'IFICATION' Date:2-27-2018
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 properly 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 ARCHPCEC'1"S llECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 2-27-2018 professional