B-2018-1397 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1397
10220 STERLING BLVD CUPERTINO,CA 95014-3826(375 24 026) HOME NETWORKS,
ELECTRIC&SOLAR
SAN JOSE,CA 95131
OWNER'S NAME: DATE ISSUED:08/20/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#820184
Contractor HOME NETWORKS ELECTRIC&SOLAR Dale Q5/31/2019 X BLDG ELECT—PLUMB
MECH 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 Basin—&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)EV CHARGING STATION(50 AMPS)-GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
1. l have and will maintain a certificate of consent to sal Finsure 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.
z. I have and will maintain Worker's Compensation Lusmronce,as in for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. - Sq.Ft Floor Arm: Valuutiom$2200.00
APPLICANT CF-RTIFICATION
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: Occnpuncy'lype:
and slate laws relating to building construction,and hereby authorize 375 24 026
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 applicant understands and will comply with all non-point
source Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature _ Date 08120/2018 Issued by:Jasmine Archbold '
Date:08/20/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-
ROOFS.-]allowing two reasons: All root's shall be inspected prior to any roofing material being installed.He roof is
1. I,as owner of the property,of my 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 or offered for inspection
sale(Sec.7044,Business&Professions Code)
x. I,as owner ofthe property,am exclusively contracting with licensed Signature ofApplioanr.
commotors to construct the project(Sec.7044,Business&Professions Code). Dale:08/20/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTER
1. 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 Cade,for the
performance oftine work forwhich this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I lonve read the hazardous m subu isls requirements under Chapter 6.95 nr the
Section 3700 o£the Labor Code,for the penfowance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I health&Safety Cade,Section 25532(x)should 1 store or handle h n admms
shall not employ n in an manner so as to Become subject to the material.Additionally,should I use equipment or devices which emit hazardous
1 y any person y J air contaminants as defined by the Bay Aren Air Quality Management District 1
Worker's Compensation laws of Califonia.If,after making this certilicatc oC will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l became subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with stich provisions or this permit shall ,
/
APPLICANT CERTIFICATION Date:0 812 012 01 8
I certify that I have read this application and slate that the above information is CONST'RUC'TION 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 MunicipalARCHITECT'S DECLARATION
Code,Section 9.18. - understand my plans shall be used as public records.
Licensed
Signature Date 08/20/2018 professional