B-2018-1340 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-1340
10805 STEVENS CANYON RD CUPERTIN0,CA 95014-3942(342 17 Ol7) MARSA ELECTRIC
SAN JOSE,CA 95127
OWNER'S NAME: - DATE ISSUED:08/08/2018
OWNER'S PHONE: PnONE NM(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC-Q Llc.#1434528
Contractor MARSA ELECTRIC Date OV311202D X BLDG X ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter9(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:
REWIRE WHOLE HOUSE;UPGRADE PANEL-(200 AMP)SAME
1 hereby affirm under penalty of perjury one of the following two de fiuratfons: LOCATION;INSTALL(3 1)LED RECESSED LIGHT(5)EXT LIGHTS;
r. I have and will maintain a certificate of consent to self-insure for Worker's (77)PLUGS AND SWITCHES;
{
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this
permit is issued, Sq.Ft Floor Area: Valuation:$14000.00
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 state laws relating to building construction,and hereby authorize 342 17017
representatives of this city to enter upon the above mentioned property for
inspection purposes.(We)agree to save indemnity 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
Date 08/08/2018 Issued by:Jasmine Archbold
Date:08/08/2018
OWNER-BUILDER DECLARATION
I hereby affirm Had I am exempt from the Cra tracter's I.dcense Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
n. I,as owner,oI 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(Sec.7044,Business&Professions Code)
x. 1,as owner ofthe property,sin exclusively contracting with licensed Signanve ofApplicrmt:
contractors to construct the project(See.7044,Business&Professions Corte). Dune:08/08/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided far by Section 3700 of the Labor Cade,fm 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 hazardous materials requirements under Chapter 6.95 of Hue
Section 3700 of the Labor Code,for the performance ofthe work I'or which this Caliiornia Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit t is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
uni
s. 1 certify that in the performance of the work for which health&Safety Code,Section 25532(x)should I store or handle hazardous
permit is issued,I material.Additionally,should 1 use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become
e subject to the air contaminants as defined by the Bay Area Air Quality Management District I
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,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be drained revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/08/2018
I certify that I have read this application and slate that the above information is CONST14LT1I9XNDING AGENCY
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,casts,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 08!08/2018 Licensed
Professional