D-2018-0039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0039
10326 PRUNE TREE LN CUPERTINO,CA 95014-2023(316 33 028) BANNISTER CUSTOM
HOMES INC
SAN JOSE,CA 95150-
5819
OWNER'S NAME: DATE ISSUED:08/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Up.#76143
Contractor BANNISTER CUSTOM HOMES INC Data 11/30/2018 _BLDG—ELECT—PLUMB
I hereby affirm that 1 am licensed ander the provisions of Chapter 9(commencing —MEC14 X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
DEMO SINGLE FAMILY DWELLING AND ATTACHED GARAGE-
I hereby affirm under penally of perjury one of the following two declarations: (1831 SF)
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.
have and will maintain Worker's Compensation Insurance,as provided Corby
Section 3700 of the Labor Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$22000,00
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: Occupmrcy Type:
and state laws relating to building conslructlon,and hereby authorize 31633 028
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 liablllties,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against sa'd City Inconsequence of the granting of ins permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ap ant un ands and will comply with all non-point
source regulatio e he upe ]�M76.e,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/0912018 Issued by:Jasmine Archbold
Dace:08/09/2018
QWN
R LDER CLA TTION
I barely affirm that I am exempt from the Contractor's License Law far one of the RE-ROOFS•
following two reasons: All roofs shall be inspected print to any roofing mut.n.I being installed.If a roof is
r, I,as owner of the property,m my employees with wages as their sole installed without first obtaining inspection,nspection,1 agree to remove all new materials for
compensation,will do die work,and the structure is not intended or offered for inspection
sale(Sec.7044,Business&Professions Code)
x. I,as owner of the property,sm exclusively contracting with licensed Signature ofApplicanC
contractors to construct the project(Scc,7044,Business&Professions Code), Data 08/09/2018
I hereby affirm wader penalty of perjury one of the following throe declarations:
r. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 1 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 this Califoroha Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. m- aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance ofthe work for which this permit is issued,l Health&Safety Codd,Section 25532(u)should 1 store or handle Imzarelous
sball not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as dented by the Buy Area Air Quality Management District I
Worker's Compensation laws of California.If,ager making this certificate of will maintain compItancewith the Cupe no Mnor
1pa Code,Chnpt .12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade, ti as 2505,25 3,and 255 4.
Labor Code,l must forthwith comply with such provisions or this permit shall _
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:08109/2018
I certlfy that I have read this application and slate that the above Information is CONSTd/
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is construction nding agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per it 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,Sectlon 9.18. 1 understand my plans shall be used as public records.
Signature Date Q8&9/2Q18 Licensed
Professional