B-2018-1403 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-1403
18740 TILSON AVE CUPERTINO,CA 95014-3858(375 17 043) HOME DEPOT U S A
INC
ATLANTA,GA 30339
OWNER'S NAME: DATE ISSUED:08/21/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRAC'TOR'S DECLARATION BUILDING PERMIT INFO:
License Class 8 C17 C39 C13 Lic.#SL 2L331
Contractor HOME DEPOT US All Date 09/30/2018 X BLDG ELECT—PLUMB
MECH X RESIDENTIAL COMMERCIAL
1 hereby affirm that I am licensed render the provisions of Chapter 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 PATIO DOOR SAME LOCATION/SAME SIZE(TO MEET
I hereby affirm under penalty of perjury one of the following two declarations: EGRESS)
i. I have and will maintain a certificate ofcoment to self-insure£or Worker's
ampensation,as provided for by Section 3700 oP the Labor Code,for the
orf",It a 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 far which this
permit is issued. Sq.Ft Floor Area: Valuation:$2100.00
APPLICAN'1'CER'fIFTCATION
1 certifythat I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances A ber: Occupancy Type:
3755 1 1743
and state laws relating to building construction,and hereby authorize 7 043 043
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 Igo DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,S It n fir-IS: ]80 DAYS FROM LAST CALLED INSPECTION.
Signature --�"-� !
I hereby affirm that lam exempt from the Contractor's License Law for one of the
following two reasons: All root's shall be inspected prim to any rooting material being installed.IF a roof is
r. I,as owner of the property,or my employee with wages as their sole installed without first obtaining on 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&prnfesamos Code). Date.8-21-2018
l hm•eby affirm under penalty of perjuy one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will melntain a Certificate of Consent to self-insure fnWorker's
Compensation,as provided f r by Section 3700 of the Labor Code,f r the
perrormauce of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have end will maintain Worker's Compensation Insurance,as provider)for by I have read the hazardous materials requirements under Chapter 6.95 of The
Section 3700 o£the Labor Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.twill
mit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
per Health&Safety Cade,Section 25532(x)should I store or handle hazardous
a. I certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Buy Area Ah,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 In of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,tritest forthwith comply with such provisions or this permit shall _..
be deemed revoked. Owner or authorized
APPLICANT CERTIFICATION Date:B-21-2018
certify that I have read this application and state that the above Information is
CONSTRUCrE1 N UENihNC ACFNCV
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,casts,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 ARCHITEC'1"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Lleensed
Signature Data 8-21-2018 professional