B-2018-0634 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0634
7504 LEEDS AVE CUPERTINO,CA 95014-5219(366 16 023) PERFECT HOMES
CONSTRUCTION
SAN SOSE,CA 95136
OWNER'SNAME: DATE ISSUED:08113/2018
OWNER'S PHONE: PHONE NO;(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#558533
Contractor PERFECT HOMES CONSTRUCTION Date 02/28/2019 X BLDG ELECT_PLUMB
I hereby affirm that 1 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 tall force and effect. JOB DESCRIPTION:
(1) New Addition 774 S.F.(139 S.F.Rear Addition,635 S.F,Front
I hereby affirm under penalty of perjury one of the following two declarations: Addition)
t. 1 have and will maintain a certificate of consent to self-insure for Worker's (2) New Front Porch 39 S.F.
Compensation,as provided for by Section 3700 of the Labor Code,for the (3) Remodel Kitchen 160 S.F.
performance of the work for which this permit is issued. (4) Remodel Bath 198 S.F.(two bathrooms)
have and will maintain Worker's Compensation Insurance,as provided for by (5) Remodel Other Living Space 1,090 S.F.
Section 3700 of the Labor Code,for the perno mance of the work for which this (6) Fully Sprinkler House
permit is issued. _
APPLICANT CERTIFICATION
I certify that I have read this eppllcatlon and state that the above Sq.Ft Floor Area: Valuation:$250000.00
information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type:
Inspection purposes. (We)agree to save indemnify and keep harmless the 366 16 023 R-3(Custom)
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point PERMIT EXPIRES IF WORK IS NOT STARTED
source regulations per the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature Date 811312018 180 DAYS FROM LAST CALLED INSPECTION.
OWN I'sR-BUIL. DECLARATION Issued by:Kim Damian
Date:08/13/2018
I hereby affirm duet I am exempt from the Contractor's License Law for one of the
fill—mg two reasons;
t. 1,as owner of the property;or my employees with wages as their sole RE-ROOFS
compensation,will do the work,and the structure is not intended or offered for Alt roofs shall be inspected prior to any roofing material being installed.If a.of is
sale(S-7044,Business&Professions Cade) installed without first obtaining an inspection,I agree to
remove all new materials for
a I,as owner ol'the property,am exclusively contracting with licensed inspection.
contractors to construct the project(Sec.7044,Business&Professions Code).
Signature of Applicant
I hereby affirm mule.penalty of perjury one of the following three declarations; Data:8/13/2018
t. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BET'T'ER
/ performance of the work for which this permit is issued.
�( I have and will maintain Worker's Compensation basurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work 1'or which this HAZARDOUS MATERIALS DISCLOSURE
IJeemit is issued. I have read the hazardous materials requirements under Chapter 6.95 of'the
California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
s. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and tine
shall not employ any person in any naumner so as to become subject to the Health&Safety Code,Section 25532(a)should I store or handle hazardous
Worker's Compensation laws of California.If,after making this certificate of material.Additionally,should I use equipment or devices which craft hazardous
exemption,1 became subject to the Worker's Compensation provisions of die air contaminants as defined by the Bay Arca Air Quality Management District I
Labor Cede,I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
be deemed revoked the Health&Safety Code,Sections 25505,25533,and 25534.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is Owner or authorized agent:
correct.I agree to comply with all city and county ordinances and state laws Date:5/13/2018
relating to building construction,and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY
to enter upon the above mentioned property for Inspection purposes.(We)agree I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit Is Issued(Sec.3097,Clv C.)
Judgments,costs,and expenses which may accrue against said City In Lender's Name
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Signature Date 8/13/2018
Licensed