B-2018-1270 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1270
19191 VALLCO PKWY CUPERTINO,CA 950t4-2525(316 20 117) ARC PACIFIC INC
GILROY,CA 95020
OWNER'S NAME:Apple Lm DATE ISSUED:08/02/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#1 r42 LA36
Contractor ARC PACIFIC INC Date 0313112019 X BLDG_ELECT_PLUMB
MECH RESIDENTIAL X COMMERCIAL
I hereby affirm that Iran licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of'the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
APPLE-T.I.-INSTALL NEW DROP T-BAR CEILING
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Lubar Code,for the
performance of the work for which this permit is issued,
[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: Valued—$32600.00
APPLICANT CERTIFICATION
I 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 3 t6 20 117
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 ofthis 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.
SignatX-- �= "°'�'"�" +""� Data 08/0212018 Issued by:Jasmine Archbold
Date:08/02/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law Por one of the RE-ROOM
fallowing two rommue All roof's shall be inspected prior to any roaring material being installed.If.roof is
L 1,as owner of the 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 structure is not intended or offered far inspection.
sale(Sec.7044,Business&Professions Code)
i. 1,as owner of the property,RM exclusively connecting with licensed Signature of Applicant:
contractors to construct the project(Sao 7044,Business&Professions Code). Date:08/02/2018
1 hereby affirm under penally of perjury one of the following three declarations:
r. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
2. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,far 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
3. 1 certify that is the perfr,rmm m of the work for which this permit is issued,I
Health&Safety Cade,Section 25532(a)should I store or handle haznrdone
shall not employ n person in an so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
p y a y I y manner J .it comhtminnnts us defined by the Bay Area AU 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 of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit all _..
be deemed revoked Owner or authorized agen
APPLICANT CFIi'1'1 FICA'I'ION Date:08/0212018
I certify that 1 have read this application and slate that the above information is CONS'fRUCfroN 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. (Wei)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.Addlllonally,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 Dale 08/0212018 Professional