B-2018-1248 (2) CITY OF CUPERTINO BUILDING PERMIT
HUI LDINGADDRESS; CONTRACTOR; PERMIT NO:B-2018-1248 ,
10491 GLENVIEW AVE CUPERTINO,CA 95014-4512(369 Il 037) Mike Counsil Plumbing
Inc
1915 Otoole Way San
Jose,CA 95131
OWNER'S NAME: DATE ISSUED:07/25/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lid,#679261
Contractor Mike Counsll Plumbing Inc Date X BLDG_ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 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. SOB DESCRIPTION:
INSTALL 2-WAY CLEAN OUT AND PARTIAL HOUSE SEWER LINE
I hereby affirm under penalty of perjury one of the following two declarations: REPLACEMENT
r, 1 have and will maintain a certificate of consent to self-insure for Worker's REV#I-INSTALL PROPERTY CLEAN-OUT AND TRENCH-LESS
Compensation,as provided for by Section 3700 of the Labor Code,for the SEWER LINE-ISSUED 08/2/2018
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: Volcatic.:$22479.00
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'lype:
and state laws relating to building construction,and hereby authorize 369 11 037
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 ofthe granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations pe:th�ecWtl Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8102/2018 Issued by:Jasmine Archbold
Data:07/25/2018
OWNER-
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed,If s roof is
r. 1,as owner ofthe property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the an is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
x. I,as owner ofthe propertgare exclusively contracting with licensed Signature ofAppliea.t:
contractors to construct the project(Sce.7044,Business&Professions Code). Date: 2/2018
I hereby afli rm under penalty of porjmy one of the following three deebrrntions: ALL ROOF COVERINGS I'D BE CLASS"A"012 BETTOR
r. 1 have and will maintain a Certificate of Consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe 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 ofthe Labor Code,for the performance,of the work for which this California Health&Safety Code,Sections 25505,25533,mrd 25534,1 will
permit is issued. m aintain eomplhmce with the Cupertino Municipal Code,Chapter 9,12 and the
s. I certify that in the performance ofthe work rat which this permit is issued,1 Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the nnneri.l,Additionally,should I use equipment or devices which emit hazardous
It emituminants as defined by the Bay Are.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 ofthe the Health&Safety Code,Sections 255 ,25533,.nd 25534,
Labor Code,I net forthwith comply with nodi provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Date:8!02/2018
I certify that I have read this application and state that the above Information is CONSTR
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.Addllienally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHI'ITSC'1"S DECLARATION
Code,Section g.18. I understand my plans shall be used as public records,
Signature Date g10212018 Licensed
Professional