B-2018-1333 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1333
19711 BIXBY DR CUPERTINO,CA 95014-3324(369 09 045) QUAN'S ELECTRICAL
CO
CUPERTINO,CA 95014
OWNER'SNAME: DATE ISSUED:08/08/2018
OWNER'S PHONE: PRONE NO:(
LICENSED Ii DECLARATION BUILDING PERMIT INFO:
License Class C-10.C-20 Up.9706512
Contractor QUAN'S ELECTRICAL CO Dale 05/3112019 X BLDG X ELECT_PLUMB
I herebyaffirm that I nm licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL—COMMERCIAL
n provis ai p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
UPGRADE MAIN PANEL-(200 AMPS)SAME LOCATION
I hereby affirm tinder penalty of perjury one of the following two declarations:
I. 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. -
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 Flaor Area: Vnlmrtion:$3600.90
APPLICANT CERTIFICATION
1 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 369 09 045 -
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 reguI tions per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/08/2018 Issued by:Jasmine Archbold
Build:08/08/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law far one of the RE-ROOFS
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a rool'is
1. I,as owner of the property,or my employees with wages as their sole nIlled without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sce.7044,Business&Professions Code)
z 1,as owner of the property,aro exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:08/08/2018 -
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I, I have and will maintain a Certilieate of Consent to self-inswe for We,
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
x. 1 have and will maintain Worker's Compensation Insurance,as provided faby I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Cade,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 Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(0 should I store or handle hazardous
shall 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 defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Calif'saia.if,after making this certificate of nyill maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,)become subject to the Worker's Compensation in of the the Health&Safety Cod,Sections 25505,25533-,and 25534.
Labor Code,I mist forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CEI2TIRICA'1'ION Date:0 810 8/2 01 8
1 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 ARC HI'I'EC7"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 0 8/0 812 01 8 Licensed
Professional