B-2018-1309 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1309
21372 MILFORD DR CUPERTINO,CA 95014-1328(326 41 092) CRAFT BUILDERS
CONSTRUCTION
MORGAN HILL,CA
95037
OWNER'S NAME: DATE ISSUED:08/09/2018
OWNER'S PHONE: PHONE No:(
LICENSED CON'TRACTOR'S DECLARATION - BUILDING PERMIT INFO;
License Class B C10 C39 Lie.#1005138
Contractor CRAFT BUILDERS CONSTRUCTION Dale 07/31/2019 X BLDG—ELECT—PLUMB
[hereby affirm that I am licensed under the provisions of Chnpter 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:
(N)28-PANEL ROOF MOUNTED PV SYSTEM-(8.4 KW)
I hereby affirm under penalty of perjury one of the following hvo declarations:
r. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofhe La
tbor Code,for the
performance of the work for which this permit is issued.
I 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:$30200.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above
into
is correct.I agree to comply with all city and county ordinances APN Number: Oceopancy'rype:
and state laws relating to building construction,and hereby authorize 32641 092
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 pert�cp,1,n,,1,nIc1pal Code,Section s.16. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/09/2018 Issued by:Jasmine Archbold
Date:08/09/2018
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law I'or one criticRE-ROON'S:
Fallowing two reasons: All root's shall be inspected prior m any roofing material being installed.If o roof is
r. I,as owner mill property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,wilt do die work,and the structure is not intended or offerer)for inspection.
,at.(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicaah
contractors to construct the project(Sec,7044,Business&Professions Code). Date:08/09/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO 119 CLASS"A"OR BETTER
t. 1 have and will maintain a Certificate of Consent to self-insure Far Worker
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 lasumue.,as provided for by I 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 Code,Sections 25505,25533,and 25534.I 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 Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any insurer so as to become subject to the natherinl.Additiounlly,should I use equipment or devices which craft hazardous
a•contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California, If,atter making this certilicalc of wilt mahuoincompliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the health&Surety Code,Settle505 5533 and 25534,
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION CERTIFICATION Date:08109/2018
I certify that I have read this application and state that the above Information is CONSTRUCTION LENDING 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,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 08100201 8 Licensed
Professlonal