B-2018-1109 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1109
21663 CASTLETON ST CUPERTINO,CA 95014-4712(356 18 064) COOPER BROTHERS
INC
SAN JOSE,CA 95123
OWNER'S NAME: DATE ISSUED:07/02/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lie.#874695
Contractor COOPER BROTHERS INC Dale 03/31/2020 X BLDG_ELECT_PLUMB
I hereby affirm that I am Unused under the provisions of Chapter 9(commencing X 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:
(N)HEAT PUMP(2);MINI SPLIT AIR HANDLERS(8)
1 hereby affirm tinder penalty of perjury one of the fallowing two declarations:
r. I have and will maintain a certificate ofconsom to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance will
the work for which this permit is issued.
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
a
permit is issued. Sq.Ft Floor Area: Valuation:$24000.00
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 356 18 064
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 ence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant undIcomply with all non-point
source
07-02-2018 Issued by:Kim Dunbar
Date:07/02/2018
OWNER
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
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
oupensation,will do the work,and the structure 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 ofApplicenr.
contractors to construct the project(Sce.7044,Business&Professions Code). Date;07-02-2018
I hereby affirm under penalty of perjury one of the following three declm•ater s: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain it 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
]. I 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 this California Health&Safety Code,Sections 25505,25533,and 25534.twill
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 far which this permit is issued,I Health&Safety Code,Section 25532(0)should 1 store or handle hazrmdons
shall not employ anyperson in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws ofC0lifomia.If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
Pe g will maintain compliance with the Cupertino Munlcl od rter Alt and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 5 25534.
LabmCode,i must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized a
APPLICANT CERTIFICATION Data:07-02-2018
I certify that I have read this application and state that the above information is O ST.0 • L DE ,
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 ARCIIITEC'f'S DECLARATH)N
Code,Section 9.18. 1 understand my plans shall br,used as public records.
Licensed
Signature Date 07-02-2018 Professional