B-2018-1261 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1261
10169 S BLANEY AVE All F CUPERTINO,CA 95014-3159(369 03 008) Lake Biltmore
Apartments
1900 S.Norfolk St Suite
150 San Mateo,CA
94403
OWNER'S NAME:Lakeeiltmore Apartments DATE ISSUED:07/31/2018
OWNER'S PHONE: PRONE No:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Lake Blltmore Apartments Date ZC BLDG_ELECT—PLUMB
1 hereby affirm that I nm licensed render the provisions of Chapter 9(commencing —MECH x RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Prefamlons 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);Remodel 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'rotal);New
Compensation,as provided for by Section 3700 of the Labor Cade,for the Condenser/Fan Coil System.Floor plans are on Master Permit Number B-
performance of die work for which this permit is issued. 2017-1522.
2. I have and will maintain Worker's Compensation Insurance,as provided far by
Section 3700 of the Labor Cade,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 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 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 IIP 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
OWNER-
I hereby affirm that I ant exempt from the Contractor's License Law for one of theRE-ROOFS:
following two rensmts! All roofs shall be inspected prior to any roofing material being installed.If a .of is
r. 1,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the struc4ue is not intended is offered for inspection.
sale(Sec.7044,Business&Professions Cade)
1,as owner of the property,am exclusively contracting with licensed Signore of Applicant:
contractors to construct the Project(Sec.7044,Business&Professions Code). Date:07/31/2018
I hereby affirm under penalty of perjury one of the fulluwing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-iustve for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance oftlre work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation insurance,as provided tar by I have read the bazarduus materials requirements under Chapter 6.95 of the
Section 3700 oftlre 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
I certify that in the pmIlbunerwo of the work for which this permit is issued,I health&Safety Code,Section 25532(.)should 1 stare m•handle hazardous
shall not employ any person in any nuance.se as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation lows of C.lifarnia.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 Code,Imam forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Data:07/31/2018
1 certify that I have read this application and slate that the above Information Is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and slate 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. dditionally,the applicant understands
and will
07131/2018 Licensed