B-2018-1259 CITY OF CUPERTINO BUILDING PERMIT
BUILD ING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1259
20776 GARDEN GATE DR CUPERTINO,CA 95014-1808(326 30 040) ARTECI4 ELECTRIC
MENLO PARK,CA
94026
OWNER'S NAME:Snyder Jennifer Hilary Et Al DATE ISSUED:07/26/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_10 Llc.#=2
Contractor ARTECH ELECTRIC Date 04/30/2019 X BLDG X ELECT_PLUMB
1 hereby affirm that 1 am licensed under the provisions of Chnpter 9(commencing —MECH 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:
UPGRADE MAIN PANEL-(200 AMP)SAME LOCATION
I hereby affirm under penalty of perJury one of the following two declarations: UPGRADE(2)SUBPANELS-(125 AMP)SAME LOCATION
I I have and will maintain a certificate of consent to self-insure for Worker's UPGRADE KITCHEN WIRING
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
z: I have and will maintain Worker's Compensation Insurance,as provided for by
Sectio3700 of the Labor Code,for the performs—of the work for which this
issued. Sq.Ft Floor Area: Valuation:$6000.00
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 All Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 30 040
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�r the Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature jC� "'� Date 07/26/2018 Issued by:Jasmine Archbold
Date:07/26/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS'
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If..or is
v 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 for inspection,
sale(Sce.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively emunu,ting with licensed Signature of Applicant.
contractors to construct the project(Sec,7044,Business&Professions Code), Date,47/26/2018
f hereby affrm under penalty of perjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTER
I 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 Cade,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 the
Section 3700 of the Labor Code,fbr the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534,[will
permit is issued maintain compliance with the Capenino Municipal Cade,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I stare 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 Imzardrrus
air contaminants as defined by the Bay Area Air Quality Management District l
Worlcer's Compensation laws of California.If,after making this certificate of will maintot.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 Code,1 must forthwith comply with such provisions or this permit shall
�be deemed revuked. Owner or authorized agent:
APPLICANT CER'fIFMION' Date:07/26/2018
Certify that have read this application and slate that the above information is CONS'f'I2l1CTION 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 ARCIII'IM'.S U'ECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records,
Licensed
Signature Date 07/26
/2018
Professional