B-2018-1327 CITY OF CUPERTINO BUILDING PERMIT
BU ILDING ADDRESS: - CONTRACTOR: PERMIT NO:B-2018-1327
10284 BYRNE AVE CUPERTINO,CA 95014-2812(357 15 078) CUPERTINO
PLUMBING INC
SAN JOSE,CA 95124
OWNEl2'SNAMEt DATE ISSUED:08/07/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRAC'TOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lie.#624905
Contractor CUPERTINO PLUMBING INC Date 04/3012020 X BLDG ELECT X PLUMB
I hereby affirm that I nm 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 fall force and effect. JOB DESCRIPTION:
1 ST FLOOR RE-PIPE(COPPER)-(8 FIXTURES)
I hereby affirm under penalty of perjury one of the following two declarations:
1. I 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
rf nuance ofthe work for which this permit is issued
f I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the pet fornranee of the was for which this
permit is issued. Sq.Ft Floor 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 357 15 078
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 Cuperllno 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 CupertjBn- un Tial Co e,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8-7-2018 Issued by:Kim Dunbar
Date:08/07/2018
OWNER-
I hereby affirm that I 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 rooting material being hist tied I£a roof is
r. 1,as owner of the property,or my employees with wages as their sole rrstaRed 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(Sec.7044,Business&Professions Code)
1. 1,as owo.,of the property,am exclusively contracting with licensed Signature of Applicnnt:
contractors to construct the project(Scc.7044,Business&Professions Code). Date:8-7-2018
I hereby affirm under penalty of pm•f ury one of the following three declnrntlons: ALL ROOF COVERINGS TO BE CLASS"A"OR BE'I"I'ER
n. I have and will maintain a Certificate of Consent to selfinsum for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfornranee ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compeussthm Insurance,as provided for by I have read the hazardous materials requh enrents 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.Twill
permit is issued, maintain complinnee with the Cupertino Municipal Cade,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(n)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should 1 use equipment m•devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califernln,It,allot-making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 rand
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Seeders 25505,2553 *5534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANTCERTIFICANION Date:88-7-2018
I certify that I have read this application and state that the above information is GONS'l'I2UCT'
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
relaling 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 ARCIII'1•EC'1"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Dale 4-1-2--M Professional