B-2018-0329 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0329
18850 BARNHARTAVE CUPERTINO,CA 95014-3602(375 33 015) CNE CONSTRUCTION
INCORPORATION
SAN JOSE,CA 95130
OWNER'S NAME: DATE ISSUED:07/16/2018
OWNER'S PHONE: PHONE NO:(408)726-2956
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.41011892
Contractor CNE CONSTRUCTION INCORPORATION Date 03!3112020 X BLDG_ELECT_PLUMB
1 hereby affirm that 1 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:
CONSTRUCT(N)2 STORY HOUSE(1985 S.F.);ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations. (415 S.F.);(N)PORCH(522 S.F.);(N)DECK(81 S.F.)
t. 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.
z 1 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.IT Flom Area:1985 Valuation:$460000.00
APPLICANT IFICA'fiON
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 33 015 R-3(Cast..)
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 appl1I a understands and will comply with all non-point
source regula un�per trA cupertlno Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Dale 0711612018 Issued by:Jasmine Archbold
Date:07/16/2018
OWNER- 2 DECLARATION
I hereby affirm that I ant exempt from the Contractor's License Law f'or one of the RE-ROOFS,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If.root'is
1, I,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
ompeasatimt,will do the work,and the structure is not intended or offered for inspection.
sale(See.7044,Business&Professions Cade)
z f,as owner o£the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sce.7044,Business&Professions Code). Data:07/16/2018
1 heroby affirm under penalty of perjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLAS3"A"OR BETTER1. 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,far 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 or 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. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 255321 should I store or handle hazardous
shall not employ any person in any manner so as to became subject to the material'Additionally,should 1 use equipment at devices which emit hazardous
air ontnminants as delined by the Bay Area Air Quality Management District 1
Worker's Compensation laws ofCalifornin.If,after making this cmtificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
caption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se m s 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 CERTIFICATION Data:07/16/2018
I certify that I have read this application and state that the above information is CQISSTR"71/0 LENDINGACENCY
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 Lende is 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
Cade,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07/16/2016 Licensed
Professional