B-2018-1364 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1364
10573 CEDAR TREE CT CUPERTINO,CA 95014-2003(316 34 019) NEW MILLENNIUM
ELECTRIC
LOS ALTOS,CA 94022-
2912
OWNER'S NAME: DATE ISSUED:08/13/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class X14 Up.#829299
Contractor NEW MILLENNIUM ELECTRIC Date 1 213 112 01 9 X BLDG X ELECT_PLUMB
I herebyaffirm that I am licensed under the ns of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
provisions p ( g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
PANEL UPGRADE(200 AMP)
1 hereby affirm under penalty of perjury one of the following two declarations:
n. 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 ofthe work for which this permit is issued.
(";Section
have and will maintain Worker's Compensation Insurance,as provided for by
j6r(";Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Rloor Area: Volumdon:$3000.00
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 stale laws relating to building construction,and hereby authorize 316 34 019
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 1S 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-paint
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Dete 8-13-2018 Issued by:Kim Dunber
Date:08/13/2018
OWNER-BUILDS DE2 ARATION
I hereby affirm that I am exempt from the Contractor's License Law 1'or oue of Che RE-ROOKS
following five reasons: All roofs shall be inspected prior to any reofing material being hastolled.if a roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining on inspection,I agree to remove all new materials for
ompensation,will do the went,and the structure is not intended or offered for inspection,
sale(Sec.7044,Business&Professions Code)
2. I,as owner of tnc property,am exclusively contracting with licensed Signature of Applicant
connectors to construct the project(Sec.7044,Business&Professions Code). Date:8-13-2018
1 hereby affirm tinder 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 of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Conhpensation Insurance,as provided for by 1 have read the hazardous materinls 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 Cade,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Hoalth&Safety Code,Section 25532(1)should I store or handle hourdous
shall not employ any person in any nmnner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
contaminants as definer)by the Bay Area Air Quality Management District 1
Worker's Compensation laws of Califonin.If,after making this certificate eF will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I beeume subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:8-13-2018
I certify that I have read this application and state that the above information is C TR 1 G GEN-V
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a cousin ction 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 liabilitles,
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.
SignatureDate 8-13-2018 Licensed
Professional