B-2018-1345 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1345
20293 NORTHCOVE SQ CUPERTINO,CA 95014-0507(316 41 064) HOME DEPOT U S A
INC
ATLANTA,GA 30339
OWNER'SNAME: DATE ISSUED:08/09/2018
OWNER'S PHONE: PHONE No:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
Llcense Class B.C17.C39.C13 Llc.95D3331
Contractor HOME DEPOT U S A INC Data 0913012018 X BLDG—ELECT_PLUMB
I hereby affirm that I nm licensed under the provisions ofChapter 9(commencing Mill 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:
INSTALL(2)RETROFIT WINDOWS-LIKE FOR LIKE TO MEET
I hereby affirm under penalty of perjury one of the following two declarations: EGRESS;INSTALL(3)PATIO DOORS
r. 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 of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performanco of tho work for which this
permit is issued. Sq.Ft Floor Arca: Vnluntion:$7087.00
APPLICANT CERTIFICATION
1 certify that I have read this application and slate 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 41 064
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 WORI{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 per the Cupertino Municipal Code,Section 9 b '~ 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 08/09/2018 Issued by:Jasmine Archbold
Date:08/09/201.8
O EMDER
I hereby affirm that f an exempt front the Contractor's License Law for one of theBE-ROOFS,
ransoms:following two All roofs shall be inspected prior to any roofing material being installed.If error is
r. 1,as owner of the property,or my employees with wages as their sale installed without first obtaining un inspection,1 agree to remove all new materials for
compensation,wilt do the work,and the structure is not intended of offered for inspection.
sale(8...7044,Business&Professions Code)
x. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicaut:
contractors to construct the project(See.7044,Business&Professions Cade). Date:08/09/2018
I hereby affirm under penalty oi'perjury une of the following three declarations: ALL ROOF COVERINGS TO 13E CLASS"A"OR BETTER
t. I have and will maintain a Certificate ofConsent 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 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 California Health&Safety Code,Sections 25505,25533,mud 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chaplet 9.12 and the
3. I certify that in the performance ofthe work for which this permit is issued,l Health&Safety Cade,Section 25532(.)should I store or handle hazardous
shall not employ an on in an manner se as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
1 y y pals y 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 nommain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 5r-3559,and 25534.
Labor Code,I most forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized ager' _
APPLICANT CERTIFICATION Date;08/09/2018
I certify that I have read this application and state that the above Information Is T AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a c nst action 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 ARCHI'TECT'S DECLARATION
Cade,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 08/09/2018
Professional