B-2018-1199 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1199
1135 SCOTLAND DR CUPERTINO,CA 95014-5060(362 26 056) WATER QUALITY
PLUMBING INC
SAN JOSE,CA 95125
OWNER'SNAME:GUPTA RAJEEV AND REETA TRUSTEE&ETAL DATE ISSUED:07/16/2018
OWNER'S PHONE: PHONE NO:(409)267-933D
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lic.#30138
Contractor WATER QUALITY PLUMBING INC Date 02/29/2020 X BLDG ELECT X PLUMB
[hereby affirm that I am licensed under the provisions of Chapter 9(commencing 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:
RE-PIPE(COPPER)FULL(15 FIXTURES)
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self-inswc for Workcr'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 ofthe Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Arun: Valuation:$7400.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above ppN Nnnmer: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 36226 O5C>
and state laws relating to building construction,and hereby authorize
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 regulations per the CuI a ti o Municipa de,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signat Date 7/16-2018 Issued by:Kim Dunbar
Date:07/16/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law far one of the RE-ROOTS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed If a roof is
r. I,as owner of the familialty,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(Seu.7044,Business&Professions Code)
e. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct tae project(Sm.7044,Business&Professions Code). Date:7/16-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I]lave 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,I will
permit is issued. rintain compliance with tine Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I rarrHealth&Safety Code,Section 25532(x)should 1 store or handle hazardous
shall not employ an erson in an so as to become Subject to the mater].].Additionally,should I use equipment or devices which craft hazardous
p y y p y manner J air coalnnationals as deflned by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will
maint In compliance with the Cupertino Municipal Code,Chnpter 12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 9'Y%53;an 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent
APPLICANT CERTIFICATION Date:7/16-2018
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 perfo area
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 1RCI ffE 'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date Mt--2M Professional