B-2018-1260 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1260
10149 S BLANEYAVE APT F CUPERTINO,CA 95014-3157(369 03 008) Lake Biltmore
Apartments
1900 S.No, St Suite
150 San Mateo,CA
94403
OWNER'SNAME:Lake Biltmore Apartments DA'Z'E ISSUED:07/30/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Llc.#
Contractor Lake Billmore Apartments Date cX 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 Division 3 of the Business&Professions Code and that my
license is in fall 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.);
1. l have an([will maintain a certificate of consent to self-insure for Worker's Remodel Kitchen(90 S.F.);Remodel Other(32 S.F,);New Lights(5 Total);
Compensation,as provided for by Section 3700 of the Labor Code,for the New Outlets(5 Total);
performance of the work for which this permit is issued. New Condenser/Fan Coil System.Floor plans are on Master Permit
x. I have and will maintain Worker's Compensation Insurance,as provided for by Number B-2017-1522,
Section 3700 of the Luber Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Are.: Valuatiun:$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 OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino MuNcipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 07/30/2018 Issued by:Jasmine Archbold
Date:07/30/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt train the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.if a roof is
1. I,as owner ofthe 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(Sec.7044,Business&Professions Code)
1,as owner or the property,ant exclusively contracting with Recused Signature of Applicann
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/30/2018
I hereby affirm mode-penalty of perjury one of the following three declarations: ALL ROOF COVER£NCS'1'O 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
x. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the h ca rdons 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 25534.1 will
permit is issued. maintain compliance with(tie 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(1)should 1 stare or handle hazardous
shall not employ any person inlay manner so as to become subject to the material.Additionally,should I use equipment or devices which mail hazardous
air contaminants us dented by the Bay Area All Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Cla to•9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety
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 permi.Additionally,the applicant understands
and will comply with all non-point sour; r gulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,
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