B-2018-1402 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1402
11136 LINDA VISTA DR CUPERTINO,CA 95014-4770(356 16 017) PLUMBER HERO INC
GRANADA HILLS,CA
91344
OWNER'S NAME: DATE ISSUED:08/21/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S RATION BUILDING PERMIT INFO:
License Class C36 Lie.#1028886
Contractor PLUMBER HERO INC Date 07/31/2019 X BLDG_ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that 1 am licensed tinder 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:
REPLACE WASTE LINES UNDER HOUSE.
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 Labor Code,for the
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the penfemiahce of the work for which this
pe it is issued Sq.Ft Floor Area: Valuation:$10000.00
I APPLICANT CERTIFICATION
certify that I have reed 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 356 16 017
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 applicagqt understands and will comply with all non-point
source regulations per be Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date B-21-2018 Issued by:Kim Dunbm•
Date:08/21/2018
OWNER-BUILDER DECLARATION
I hereby at'lu•m 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 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,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)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code). Data 8-21-2018
1 hereby affirm under penalty at'perjury one of the following three declarations; ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 Labor Code,for the
performance ofthe 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 and the haznrdous materials requirements ander Chal ler 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 compliance with the Cupertino Municipal Code,Chapter 9.12 and tire
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store at-handle hazardous
shall hot employ any person in any rammer so as to become subject to the material.Additionally,should less equipment or devices which emit hazardous
air contaminants as defined by the Buy Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Mt icipal Code,Chapter 9.I2 mrd
exemption,I become subject to the Worker's Compensation provisions of the the health&Solely Codc,$
Labor Code,I most forthwith comply with such provisions or this permit shall (/^
be deemed revoked. Owner or authorized agent:
APPLICAN"1'CER'1'1FICA1'lON Data:B-21-2018
I certify that I have read this appllcalion and state that the above information Is CONSTRUCTION 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 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 ARC111TECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 6-21-2018 professional