B-2018-1258 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1258
22575 SALEM AVE CUPERTINO,CA 95014-5648(342 12 10l) STEPHANIE NAYLOR
720 NORTHROP SAN
JOSE,CA 95126
OWNER'S NAME:Peng David And Ying Trustee DATE ISSUED:07/26/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=20 Lip.#759A46
Contractor STEPHANIE NAYLOR Date 06130/2019 X BLDG—ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
REPLACE(2)FURNACES-SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE(2)A/C UNITS-SIDE YARD SAME LOCATION
t. 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
3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Fluor Area: Valuation:$17000.00
APPLICANT CERTIFICATION
I certify that I have read thisapplication and slate 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 342 12 101
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
Contractor's License Law for one of the RE-HOOFS:
fall—fig two reasons: All roofs shall be inspected prior to any rooting material being installed,If a roof is
t. 1,as owner of the property,.or my employees with wages as their sale installed without first obtaining an nspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended of offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. f,as owner of the property,am oxclusivcly contracting with licensed Signature ofApplieunl:
contractors to construct the project(Sea 7044,Business&Professions Code). Date:07/26/2018
1 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 Section 3700 of the Labor Code,for the
performance of the 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 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Permit certify Ilealth&Safety Cade,Section 25532(a)should l store or handle hazardous
a. I certify that in the performance ofthe nce,woran a which tris permit is issued,I material,Additionally,should 1 use equipment or devices which emit hazardous
shall not employ any person in any inamrer so as to become subject to the contamim muses 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 Co e°C apter 9.12 red
exemption,l become subject to the Worker's Compensation provisious of the the Health&Su£
)
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. I understand my plans shall be used as public records.
Signature Date 07/26!2018 Licensed
Professional