B-2018-1229 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-1229
10326 PRUNE TREE LN CUPERTINO,CA 95014-2023(316 33 028) BANNISTER CUSTOM
HOMES INC
SAN JOSE,CA 95150
5819
OWNER'S NAME:Tran Khai And Mary Ann Hong G DATE ISSUED:07/23/2018
OWNER'S PHONE: PHONE NO:(650)400-1824
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#7(1
Contractor BANNISTER CUSTOM HOMES INC Date 11/30/2018 X BLDG X ELECT—PLUMB
1 hereby affirm that I am licensed ander the provisions of Chapter 9(commencing MECII X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
(N)TEMPORARY POWER POLE(200 AMP)
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-insure for Worker's
or
Compensation,as provided for by Section 3700 of the LabCode,for the
fo
perrmance ofthe work for which this permit is issued.
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.Ft Floor Area: Valuation:$1800.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31633 028
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,casts,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 app!'and nude ands end will comply with all non-point
source regulation he pe no nyulepa Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature � 07/23/2018 Issued by:Jasmine Archbold
Date:07/23/2018
O NER UILDER Df/CLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be impeded prior to any roofing material being installed If a roof is
r. 1,es owner of the property,or my employee's 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 structureis not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z, I,as owner of the property,no exclusively contracting with licensed Signahae ofApplicanC
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/23/2018
I 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 Scetion 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of due
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 aloodr,compliance with the Cupertino Mnnlcipal Cade,Chapter 9.12 and the
certify s. I that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the naterml. Additionally,should I use equipment m devices which emit hazardous
air contaminants as depend by the Bay Aron Air Quality Management District I
Worker's Compensation Taws of California.IF,atter making this certificateaf will maintain compliance with the Cupar'o Mwdcip o ,Chapter Alt and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S o 25505, 53 mrd 25574
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:0712312018
I certify that I have read this application and Slate that the above information is CONSTR TION LENUI AGENCY
correct. agree to comply with all city and county ordinances and state laws I hereby affirm that there is 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 Ilabilitles,
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 DECLARNHON
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07/23/2018 Licensed
Professional