B-2018-1262 CITY OF CUPERTINO BUILDING.PERMIT
BIIILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-1262
10149 S BLANEY AVE APTA CUPERTINO,CA 95014-3156(369 03 008) Lake Biltmore
Apartments
1900 S,Norfolk St Suite
150 San Mateo,CA
94403
OWNER'SNAME:Lakefiltmore Apartments DATE ISSUED:07/30/2018
OWNER'S PHONE: PHONE
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lip.#
Contractor Lake Biltmore Apartments Date X BLDG ELECT_PLUMB
I herebyaffirm that I am licensed under the t'Cha ter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
, provisions o p (con g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
THE BILTMORE APARTMENT-Remodel Apartment:UNIT A
I hereby affirm under penalty of perjury one of the following two declarations: "BISMARK".Remodel Bath(49 S.F,);Reumdel Kitchen(90 S.F.);Remodel
r. 1 have and will maintain a certificate of consent to self-insure for Worker's Other(32 S.F.);New Lights(5 Total);New Outlets(5 Total);New
Compensation,as provided for by Section 3700 of the Labor Code,for the Condenser/Fah Coil System.Floor plans are on Master Permit Number B-
performance of the work for which this permit is issued. 2017-1522.
z. I 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:$16800.00
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 . 36903 008
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 012
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 Date 07130/2018 Issued by:Jasmine Archbold
Date:07/30/2018
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law fo.one of tine BE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roadng material being installed,If a roof is
v I,as owner of the property,or my employees with wages as their sole installed without first obtaining no inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection,
,to(See.7044,Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant;
contractors to construct the project(Sec.7044,Business&Professions Code). Dale:07/30/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Cousent to self-insure far Worker's
Compensation,as provided Corby Section 3700 of the Labor Code,for the
performance of the work For which[his permit is issued. HAZARDOUS MATERIALS DISCLOSURE
x. I have and will maintain Worker's Compensation Insurance,as provided far by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance or the 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
I certify 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 Imzardons
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 Air Quality Management District I
Worker's Coinpeusatlou Inws of California.If,afar making this certificate of will maintain eampliunce with the Ctq erthm M nieipal Code,£Ir er 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health 11 Safety.
)
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
07!30/2018 Licensed