B-2017-1473 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1473
10326 PRUNE TREE LN CUPERTINO,CA 95014-2023(316 33 028) BANNISTER CUSTOM
HOMES INC
SAN JOSE,CA 95150-
5819
OWNER'S NAME: DATE ISSUED:08/15/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO;
License Class B LIc.#701434
Contractor BANNISTER CUSTOM HOMES INC Date 11/30/2018 X BLDG—ELECT_PLUMB
MECI3 X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under 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:
(N)TWO STORY SFD(3369 SF);BASEMENT(1785 SF);ATTACHED
I hereby affirm under penalty of perjury one of the following two declarations: GARAGE(429 SF);PORCH(361.6)
t. 1 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 of the work for which this per is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
/ Section 3700 of the Labor Cade,for the performance of the work for which this
Permit is issued. Sq.Ft Floor Area:5127 Valuation:$769050.00
APPLICANT CER1'IF1CA'1'ION
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 316 33 028 R-3(Custom)
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 stppll ant understands and will comply with all non-point
source regulations r hs cup =Date
section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature 8-15-2018 Issued by:Kim Dunbar
Date:08/15/2018
ER ILDER DE LAIZATIG
I hereby affirm that Into exempt frnm the Contractor's License Law for one of the RE-ROOFS:
following two reasons All reefs shall be inspected prior to any m.fmg material being installed.If a,roof is
r, 1,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(Sce.7044,Business&Professions Code)
z I,as owner of the property,sm exclusively contracting with licensed Signature o£Applicant
contractors to construct the project(Sec.7044,Business&Professions Cade). Date:8-15-2018
I hereby affirm under penalty of perjury one of the following three declarations:aratis: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTER
v 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,too the
Pat formance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I 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 Code,for the performance Of the wok for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain..pitance with the Cmerthm Municipal Code,Chapter 9.12 and the
s. 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 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 hazm'dous
Worker's Cam ensation laws of California.If,after making this certificate of contaminants as defined by the Bay Area Air Quality Management District I
P g airwillcmaintain compliance with the Caper ino Mnn''p I Code, hapler'.12 mid
exemption,I become subject to We Worker's Compensation provisions of the the Health&Safety Code, as 25 5,2 33,an 25534,
Labor Code,I must forthwith comply with such provisions or this permit shall
be doomed revoked, - Owner or authorized agent:.
AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 8-15-2018 Licensed
Si
9 Professional