B-2018-1213 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1213
21470 VAI AVE CUPERTINO,CA 95014-4935(362 05 023) WEGNER
CONSTRUCTION INC
CAMPBELL,CA 95129
OWNER'S NAME:MURTHYNAGARAJ TRUSTEE DATE ISSUED:07/17/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#972553
Contractor WEGNER CONSTRUCTION INC Date 05/31/2020 X BLDG_ELECT X PLUMB
1 hereb affirm that 1 am licensed under the f Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
y e provisions a p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE WATER HEATER-SAME LOCATION;
I hereby affirm under penalty of perjury one of the folloving two declarations: REPLACE"MIDDLE"BEDROOM'S WATER DAMAGED SHEETROCK
r. I have and will maintain a certificate of consent to self-insure for Worker's AND ELECTRICAL DEVICES-SEE PLAN
_Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 orthe Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Arca: Valuation:$120000.00
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 36205 023
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 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,
Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/17/2018 Issued by:Jasmine Archbold
Date:07/17/2018
OWNER-BUILDER DECLARATION
I hereby¢Mr.,[],at I am exempt from the Contractor's License Law for one at'ti aRE-ROOFS,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a rootis
r. 1,as owner of the 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 fur inspection.
able(Sm.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicaiit:
contractors to construct the project(See.7044,Business&Professions Code). Date:07/17/2018
1 hereby affirm under penally of perjury one of the following three declarations; ALL ROOF COVERINGS TO BE CLASS"A"Oil BETTER
n. 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,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazsrdons materials requirements under Chapter 6.95 or the
Section 3700 of the Labor Code,for the performance oI nor 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
a. 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 n n in an to become subject to the 'material.Additionally,should 1 use equipment or devices which emit hazardous
p y a y person y m¢nner so as 1 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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the HeNth&Safety Code do a 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICAN'C CERPIFICATION Date:07/17/2018
1 certify that I have read this application and state that the ahove 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 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 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,
Signature Date 07/1712018 Licensed
Professional