B-2018-1265 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERloUT NO:B-2018-1265
10408 DENISON AVE CUPERTINO,CA 95014-2429(316 29 07 1) B J ELECTRIC INC
SAN JOSE,CA 95125
OWNER'S NAME: DATE ISSUED:07/27/2018
OWNER'S PHONE: PRONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class C-10 lc.#849295 X BLDG X ELECT_PLUMB
Contractor B J ELECTRIC INC Date 11/30/2018
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 ef'f'ect. JOB DESCRIPTION:
UPGRADE PANEL-(200 AMP)-SAME LOCATION
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valuation:$3000.00
APPL,2T .FRTIFICATION
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 29 071
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 Ilabillties,judgments,costs,and expenses which PERMIT EXPIRES IF WORD 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
Date:07/27/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt Brom the Contractor's License Law for one of theRE-ROOFS:
following two reasons: All root's shall be inspected prior to any roofing pictorial being installed.If a out is
v 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(Suc.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Seo.7044,Business&Professions Code), Date,0 /2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
n. 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 ofthe 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 performance of the work for which[his 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. I certify that in the performance of the work for which this permit is issued,I Health&Safely Code,Section 25532(.)should 1 store or handle hazardous
shall not employ any person in any manner so as to became subject to the inuterial.Additionally,should I ase equipment or devices which emit hazardous
alr contomtnmts as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California,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,
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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07/27/2018 Licensed
Professional