B-2018-1248 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1248
10491 GLENVIEW AVE CUPERTINO,CA 9501(369 l l 037) Mike Council Plumbing
IiolOtoe Way San
lase,CA 95131
OWNER'S NAME: DATE ISSUED:07/25/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lid.4679261
Contractor Mike Counsil Plumbing Inc Date X BLDG ELECT X PLUMB
I herebyform that I am licensed under the provisions of Chapter 9 _MECH X RESIDENTIAL_COMMERCIAL
a p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall farce and effect. JOB DESCRIPTION:
INSTALL 2-WAY CLEAN OUT AND PARTIAL HOUSE SEWER LINE
I hereby affirm under penalty,of perjury one of the fallowing two declarations: REPLACEMENT
r. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,es provided for by Section 3700 of the Labor Cade,for the
issued. Sq.Ft Floor Arco: Valuation:,$22479.00
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above
information is correct.I agree to comply with all city and county ordinances APN Number: OceapancyType:
and state laws relating to building construction,and hereby authorize 369 11 037
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 regula ions per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/25/2018 Issued by:Jasmine Archbold
Date:07/25/2018
OWNER-
I hereby affirm that 1 not exempt train the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs slid]]be inspected prior to any roofing material being installed.If a roof is
r. I,as owner 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 die 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 ofAppliaant:
contractors to construct the project(Sce.7044,Business&Professions Code). Date:07/25/2018
1 hereby offiro under penalty of perjury ane of the following tbrea declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent m self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
Pat formance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the pertbrmmce of too 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 Code,Section 25532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the notoria I,Additionally,should I use equipment or devices which emit hazardous
air cnntaminnnts as defined by the Bay Area At,Quality Management District 1
Worker's Compensation laws of Ca]ifovia.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 2550, 5533,and 25534,
Labor Code,I must forthwith comply with such provisions or this permit shall
be doomed revoked. Owner or authorized agent.
APPLICANT CE12'1TFICA'1'ION Data;0712512018
I certify that I have read this application and state that the above Information is
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Clv 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 ARC1HTEcT,S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07/25/2018 Licensed
Professional