B-2018-1376 CITY OF CUPERTINO BUILDING PERMIT
BE ILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-1376
23500 CRISTO REY DR UNIT 508E CUPERTINO,CA 95014-6535(342 53 207) BAY AREA
ENTERPRISE
SAN 705E,CA 95148
OWNER'S NAME: DATE ISSUED:09/14/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CON'TRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lid,#817817
Contractor BAY AREA ENTERPRISE Dale 03/31/2019 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license Is in fall force and effect. JOB DESCRIPTION:
UNIT 509F-INSTALL LED RECESSED LIGHTS(7);OUTLETS(21);
I hereby affirm under penalty of perjury one of the following two declarations: SWITCHES(12);REPLACE(2)BATHROOM FAN;UPGRADE TUB
r, I have and will maintain a certificate of consent to self-insure for Worker's SURROUNDED WALL TO CULTURED MARBLE AND VALVE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued,
I I have and will maintain Worker's Compensation Insurance,as provided for by
is issued. Sq.Ft Fluor Aron: Valentina:$18000.60
APPLICANT CF,RTIFICATION
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 342 53 207
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 012
Additionally,the applicaj understands and will comply with all non-point
sourceroreg/
I hereby affirm 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 rooting material being installed,If a roof is
t. 1,as owner of the pr m
roperty,ca 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 the structure is not intended er offered for inspection.
sale(Sae.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). Date:
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BE'T'TER
i. 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 permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the Inumrduns m ouniots requirements under Chapter 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.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in die performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
air contaminants as defined by the Buy Area At,Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will ne inhdn aumphanec with the Cuy�ur!.5 M uiirip I Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&
;
APPLICANT CERTIFICATION Date:
I certify that I have read this application and slate 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 ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Data Professional