B-2018-1324 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1324
21810 EATON PL CUPERTINO,CA 95014-1182(326.19 t44) AMERICAN VISION
WINDOWS INC
SIMI VALLEY,CA
93065
OWNER'S NAME: DATE ISSUED;08/06/2018
OWNER'S PHONE: PITONE NO:(
LICENSED CONIRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lip.#778326
Contractor AMERICAN VISION WINDOWS INC Date 05/31/2020 XX BLDG ELECT_PLUMB
I hereby (firm that I am licensed under the _MECH X RESIDENTIAL_COMMERCIAL
a provisions of Chnpter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE(5)RETRO-FIT WINDOWS L110E FOR LINE-TO MEET
I hereby affirm order penalty of perjury one of the following two declarations: EGRESS
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compeusation,as provided for by Section 3700 of the Labor 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.Pt Floor Arca: Vaholimc,$4128.00
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 326 19 144
representatives of this city to enter upon the above mentioned property for
inspection purposes.(We)agree to save Indemnlfy and keep harmless the
City of Cupertino against liabilities,Judgments,costs,and expenses which PERMIT EXPIRES IF WORT{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 ll non-point
source regula ns per he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Slgnalure Date 08/06/2018 Issued by:Jasmine Archbold
Date:08/06/2018
OOV_N ER- , TIO
I 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.To roof is
1. 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 Bre structure is not intended or offered for inspection,
sale(Sce.7044,Business&Professions Cade)
z. I,as owner of the property,am exclusively contracting with licensed Signature o£Appliesat:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/06/2018
I hereby affirm under penalty of perjury one ot'the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I haveand will maintain a Certificate of Consent to self-iman c for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work I'm which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z. 1 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 of the Labor Corte,for 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
s. 1 certify that in the performance of the work for which this permit is issued,I health&Safety Code,Section 25532(a)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 ol'California.IF,atter making this ccrtilicate of wig maintain compliance with Bre Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Stio s 05,25533,mrd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. - Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/06/2018
1 certify that I have read this application and state that the above Information is CONSTRUC'
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction Iendi g 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 MunicipalAIiCibiieiCT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 08106/2018 Licensed
Professional