B-2018-1318 CITY OF CUPERTINO BUILDING PERMIT
DO ILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-1318
10277 VISTA KNOLL BLVD CUPERTINO,CA 95014-1033(326 13 126) 'rRADfS"PONE
MOUNTAIN VIEW,CA
94043
OWNER'S NAME: DATE ISSUED:08/06/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.4981246
Contractor TRAD ISTONE Date 02128/2019 X BLDG X ELECT X PLUMB
I hereby affirm that f am licensed under the provisions of Chapter 9(commencing —MECII X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
Becnse is in full force and effect. SOB DESCRIPTION:
NEW GAS LINE TO EXISTING FIREPLACE(1);NEW ELECTRICAL
I hereby uffirm made•Penalty of perjury one of the following two declarations: OUTLET;NEW GAS INSERT(1)
I have and will mnintain 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 Ploor Area: Valuation:$6000.00
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 Type:
and state laws relating to building construction,and hereby authorize 326 13 126
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
per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature - Data
8t3 1 Issued by:Kim Dunbar
Date:08/06/2018
�OWNER-BUIL 'RDFCLARATION
II hereby Brm that I nm exempt from the ConMactor's License Law I'or one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
a. 1,as owner of the property,am exclusively contracting with licensed Signature o'Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Date:8s-2018
I hereby affirm trader penalty aril our of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the Imrardous 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,and 25534.I will
permit is issuod. 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 1 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 hasgrdous
Worker's Compensation laws of Califonia.If,after making this certificate of am contaminants co pl ance wned h the Bay Area Air Quality "b"Cho
for
District. 1
P 6 will maintain compliance with the Cupertino nlcipal Codc,Cluapter 9.12'mnd
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Section 5 O5,25533,and 25534.
Labor Cade,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:8-6-2018
I certify that I have read this application and slate that the above information Is CONSTIIBe ION 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 Clty 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.
Licensed
Signature Date L-L-241_6 Professional