B-2018-1170 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1170
20739 SUNRISE DR CUPERTINO,CA 95014-2928(359 10 029) HOME DEPOT U S A
INC
ATLANTA,GA 30339
OWNER'S NAME: DATE ISSUED:07/11/2018
OWNER'S PHONE: PHONE NO:(678)556-7740
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C-39,C-13 LIC.#60233
Contractor HOME DEPOT U S A INC Date 09/30/2018 X BLDG ELECT_PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
n p p (commencing
with Section 7000)at'Division 3 of the Business&Professions Cade and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE(14)WINDOWS-TO MEET EGRESS
1 hereby affirm under penalty of perjury one of the following two declarations:
1. I 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.
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
permit is issued. Sq.Ft Flom Area: Vacation:$14494,00
APPLICANT CERTIFICATION
I certify that I have read this application and slate 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 10 029
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 Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/11/2018 Issued by:Jasmine Archbold
Date:07/11/2018
Q)YNER-B ILDER DECLARAT
41
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two= All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. 1,as owner ofthe property,or my employees with wages as their sole installed without lust obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the sit ncttue is not intended at offered for inspection.
sal,(So,.7044,Business&Professions Code)
i. L as owner of flue property,am exclusively contracting with licensed Signature afApplicann
contractors to construct the project(Sec,7044,Business&Professions Code). Date:07/111/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
perfarmance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Wm ker's Compensation Insurance,as provided for by I have read the hazardous materials requh ements 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 25534.1 will
mit is issued. aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
pet m Health&Safety Cade,Section 25532(,)should 1 store or handle hazardous
a. 1 certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the airontaminants 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,Clmpter 9.12 and
exemption,I.becone subject to the Worker's Compri—tom provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICAT[ON Date:07/1112018
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AG.111V
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 ARCIII'1'5'.,I llECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 07/11/2018
Professional