B-2018-1308 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOM PERMIT NO:B-2018-1308
10081 PHAR LAP DR CUPERTINO,CA 95014-1111(326 18 025) BAY BUILDERS&
REMODELING INC
SAN JOSE,CA 95131
OWNERISNAME: DATE ISSUED:08/02/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C36 Llc.#1Q12789
Contractor BAY BUILDERS&REMODELING INC Date 04/30/2020 X BLDG ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Dtvlsion 3 of the Business&Professions Code and that my
license is to full force and effect. JOB DESCRIPTION:
BATHROOM REMODEL(2)(121 SF)
1 hereby affirm ander penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self-insure for Worker's
Sq.Pt Floor Arca: Valuation:$25000.00
APPLICANT CER
TH�iCATION
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 stale laws relating to building construction,and hereby authorize 326 18 025
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 applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ._� "�""'� Dale 8-2-2018 Issued by:Kim Dunbar
Date:08/02/2018
OWNER-
1 hereby affirm that I am exempt from the Contractor's License Low for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.if e roof is
r. 1,m 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 for inspection.
sale(See.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicanu
contractors to construct the project(SeoJ044,Business&Professions Code). Date:8-2-2018
I hereby affirm under penalty of perjury one of the following three dedarm ions: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 Code,for the
performance ofthe work for which this per is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I(nave read the hazardous materials requirements under Chapter 6.95 of 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. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this per 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 material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Ali-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 Health&Safety Code,Sections 25505,25533,and 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: .
APPLICANT CERTIFICATION Data:B-2-2016
I certify that I have read this application and state that the above information is CONSTRUCTION
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.
SignatureDate 8-2.2018 LiPrcensed
ofessional