B-2018-1204 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1204
APEX DEVELOPMENT
GROUPLLC
2059 Camden Ave SAN
JOSE,CA 95124
OWNER'S NAME:DMJ HOME SOLUTIONS LLC DATE ISSUED;07/16/2018
OWNER'S PHONE: PHONE NO:(408)799-6263
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#1033746
Contractor APEX DEVELOPMENT GROUP LLC Date 12131/2019 X BLDG X ELECT_PLUMB
1 hereby artium that 1 am licensed render 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:
(N)TEMPORARY POWER POLE(100 AMP)
1 hereby affirm under penalty of perjury one of the following two declarations:
n. 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 Cade,for the
performance of the work for which this permit is issued.
Werave and will maintain Worker's Compensation Insurance,as provided for by
action 3700 of the Labor Code,for the performance of the work for which this
mit is issued. Sq.Ft Flour Arcs: Valuation:$1000.00
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 At N Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 30 094
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,t�p�thein.
s a d will co lywith all non-point
source repo Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature) Date 07/16/2018 Issued by:Jasmine Archbold
Date:07/M/2018
OWNER BUILDER ION
1 hereby affirm than I ant 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
n. I,as owner of the property,or my employees with wagon as their sole installed without fust 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 of the property,am exclusively contracting with licensed Signature ofApplicanC
contractors to construct the project(Sec.7044,Business&Professions Code), Date:07/16/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure£o 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 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,far the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work far which this permit is issued,I Health&Safety Code,Section 25532(.)simuld 1 store or handle hazardous
shot[not employ any person in any manner sons m become subject to the r;fereal.Additionally,should I use equipment or devices which emit hazardous
contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,offer making this certificate of will maintain compliance with the
Labor Cade,I must forthwith comply with such provisions or this permit shall (//
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Date:07/16/2018
I certify that I have read this application and state that the above information is CONST U 'ION LENDIN 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 07/16/2018
Professional