B-2018-1290 CITY OF CUPERTINO BUILDING PERMIT
IIUI"DING ADDRESS: - CONTRACTOR: PERMIT NO:B-2018-1290
20217 NORTHBROOK SQ CUPERTINO,CA 950(4-0501(316 39 033) THE HONEST
PLUMBER
BAKERSFIELD,CA
93308
OWNER'SNAME:HSUCHECIIIAANDTSENGAMY DATE ISSUED:07/31/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class C-36 Lic.#2j9M
Contractor THE HONEST PLUMBER Date 07/31/2020 X BLDG_ELECT X PLUMB
1 hereby affirm that 1 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]'oil force and effect. JOB DESCRIPTION:
(N)50 GALLON WATER HEATER-SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Lebon Code,for the
is issued. Sq.Ft Floor Are.: Valuation:$1200.00
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 316 39 033
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 IlabliVes,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 nderstands and will comply with all non-point
source regulati
I hereby affirm that I sin exempt from the Contractor's License Law for one of the RE-ROOFS:
following I reasmrs: All roofs shall be inspected prior to any roofing material being installed Us roof is
r. 1,as wncl 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 Structure is not intended or offered for inspection.
sale(Sec,7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sce.7044,Business&Professions Code), Date:07/31/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVER[NGS'1'O BE CLASS"A"Oil 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 per is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Cmnpensation Insurance,as provides(for by I have read the hazardous materials requirements under Chapter 6.95 utile
Section 3700 of die 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 the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cede,Section 25532(x)should I store or handle hazardous
shall not eroptay any person iu any mamter so its to become subject to the material.Additionally,should I use equipment or devices which endt hnzardons
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Cuhifornia.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 sort
exemption,I become subject to the Worker's Compensation provisions of the the He Ill&S ty Code,S tion 505,2 33-,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be doemcd revoked, Owner or authorized agent:
APPLICANT CERTTFiCAT101N Dale:0713112018
I certify that I have read this application and state that the above Information is CON ST'RUC'
)
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. 1 understand my plans shall be used as public records.
Signature Data 0 713 112 01 8 Licensed
Professional