B-2018-1292 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-1292
1100 ELMSFORD DR CUPERTINO,CA 95014-4909(362 06 004) THE HONEST
PLUMBER
BAKERSFIELD,CA
93308
OWNER'SNAME:VENKAT BHARAT K AND BHARAT APARNA TRUSTEE DATE ISSUED;07/3112018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lic.#919339
Contractor THE HONEST PLUMBER Date 07/31/2020 X BLDG ELECT X PLUMB
I 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 full force and effect. JOB DESCRIPTION:
(N)40 GALLON WATER HEATER-SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
a. 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(lie
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 orthe Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: 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 IN nber: Occupancy Type:
and state laws relating to building construction,and hereby authorize 362 06 004
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 S'T'ARTED
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
1 hereby affirm that 1 am exempt from the Contractor's License Lmv 1'or are of the RE-1200 FS;
following hvn reasons: All roofs shall be inspected prior to any roofing material being installed.If a of is
r. I,a .,all of the 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(Sce.7044,Business&Preressions Code)
z. I,as owner ofthe property,am exclusively contracting with licensed Signature ofAppfcand
contractors to construct the project(Sol 7044,Business&Professions Code). Date:07/31/2018
I hereby affirm under penalty of perjury one of the following three declarations; ALL ROOF COVERINGS TO¢E 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 1 have read the Imzardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Cade,for the performance of the work for which Chis California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. m aintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this,permit is issued,I health&Safety Code,Section 25532(a)should I store or handle hozm-dons
shall not employ any person in any manner so as to become subject to the material.Additiomdly,slmuld I use equipment or devices wldch emit hazardous
air contaminants as defined by the Bay Arca Air Quality Management District I
Worker's Compeusation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter9.12 and
exemption,I become subject to the Worker's Compensation previsions of the 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 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 0713112018 Licensed
Professional