B-2018-1405 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMTNO:B-2018-1405
1161 CRESTLINE DR CUPERTINO,CA 95014-5034(362 29 035) M114LE COUNSIL
PLUMBING INC
SAN JOSE,CA 95131
OWNER'S NAME: DATE ISSUED:08/21/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lie,#679261
Contractor MIKE COUNSIL PLUMBING INC Date 04/30!2019 X BLDG_ELECT X PLUMB
I hereby affirm that 1 nm licensed under the provisions at'Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in ILII force and effect. JOB DESCRIPTION:
(N)40 GALLON WATER HEATER-SAME LOCATION-WITH
I hereby affirm under penalty of perjury one of the following two declarations: EXPANSION TANK AND PRESSURE RELIEF VALVE
m. 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 of the work for which this permit is issued.
/
Section 3700 of the Labor Code,for the performarim of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5000.00
APPLICANT CERTIFICATION
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 slate laws relating to building construction,and hereby authorize 36229 035
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnlfy and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORI{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 applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/21/2018 Issued by:Jasmine Archbold
Date:08/21/2018
OWNER-BUILDER DECLARATION
I hereby nt'ilrm 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 e roof is
n. 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 dre structure is not intended or offered for inspection.
sale(Seo.7044,Business&Professi.es Cade)
z. 1,as owner of dm property,am exclusively contracting with licensed Signature ofApplicane
contractors to construct the project(Sec.7044,Business&Professions Code), Date,08/21/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr. l have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of clic Labor Cade,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,ns provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Lobo,Code,fits the performance of the work for which this California Health&Solely Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazarduas
shall not employ any person in tiny manner so as to become subject to the erinl.Additionally,should I use equipment or devices which emit hazardous
ofmntr contaminants as detlned by the Bary Are.Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the Floe Health&Safety
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.
Signature Date 08/2112018 Licensed
Professional