B-2018-1205 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1205
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 BUILDING PERMIT INFO:
License Class B Lic.#1033746
Contractor APEX DEVELOPMENT GROUP LLC Date 12/31/2019 X BLDG X ELECT_PLUMB
1 hereby affirm that I am licensed under the provisions ofChapter 9(commenting MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 ofthe 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 five declarations:
i. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Cade,for the
performance of the work for which this permit is issued.
Oarv
n and will maintain Worker's Compensation Insurance,as provided forby
tin 3700 ofthe Labor Code,for the performance ofthe work for which this
mit is issued. Sq.Ft Floor Arca: Vnlnatinn:$1000.00
APPLICANT CERTIFICA•f10N
I certify that I have read this application and state that the above APN NbOT
information is correct.I agree to comply with all city and county ordinances nmcr: cai panty ype:
and state laws relating to building construction,and hereby authorize 32622 036
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 applig derstand a will comply with all non-point
source regel' ,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Dale 07/16/2018 Issued by:Jasmine At
Date:07/16/2018
OWNER-BU DER DECLARATION
1 hereby uMrm that I am exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof N
r. 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
compensation,will do the work,and the structure is not intended or offered for inspection.
sae(See.7044,Business&Professions Code)
z. 1,as owner ofthe property,am xclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sce.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 HE CLASS"A"OR BETTER
i. I have and will maintains Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Coda,for the
performance ofthe 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 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit Is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants 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 C 41n unlegar Cade,Ch '979.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety
Labor Code,1 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 lhls application and state that the above information Is CONSTRU ION LENDI E C
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction tending agen 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 Iiabilitles,
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.
Licensed
Signature Date 07!1612018 Professional