B-2018-1098 (2) CITY OF CUPERTINO BUILDING PERMIT
HU ILDINGADDRESS: CONTRACTOM PERM IT NO:B-2018-1098
10211 MILLER AVE CUPERTINO,CA 95014-3465(369 14 020) PRUDHON BUILDERS
SCOTTS VALLEY,CA
95066
OWNER'S NAME: DATE ISSUED:06/2812018
OWNER'S PHONE: PHONE NO;(
LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lia#778376
Contractor PRUDHON BUILDERS Date 03/31/2020 X 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 full force and effect. JOB DESCRIPTION:
KITCHEN REMODEL(200 SF)
I hereby affirm under penalty at'perjury one of the following two declarations: REV#1-REMOVING INTERIOR WALL-KITCHEN-ISSUED
1. I have and will maintain a certificate of consent to self-insure for Worker's 07/26/2018
Compensation,as provided faby Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perform cc of the work for which this
permit is issuer(. !fin `- Sq.Ft Flom-Area: Valuation:,$30000.00
AP CCPV� IT N
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 369 14020
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 th Cupertlno ,nnicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 0712612018 Issued by;Kim Dunbar
Date:0 6/2 812 0 1 8
OWNER-BUILDER
I herebyoff vm that I are exempt from the Confrnctar's License Law for one of theRE-ROOFS:
following two reasons: All roofs shall be inspected prior to any rooting material being installed.Ira roof is
1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 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&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature ofAppllcanC
contractors to construct the project(See.7044,Business&Professions Code). Date:07/26/2018
1 hereby affirm order penalty of perjury one of the following[Ince declarations: ALL 1200E COVERINGS TO 13E CLASS"A"OR BETTER
1. 1 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
i. I haw and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous matetiots 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
permitis issued. maintain aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Ilenith&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I material.Additionally,should 1 use equipment or devices which emit I—ardnus
shall not employ any on lam in any manner so as le become subject li the air contaminants ns relined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.lf,alien making this certifecate aP will maintain compliance with the Cuperti I "helps'
Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety
correct.I agree to comply with all city and county ordinances and state 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.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHIT'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Dale 07/26/2018 Licensed
Professional