B-2018-1348 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1348
19140 STEVENS CREEK BLVD APT B202 CUPEXPINO,CA 95014-2571(375 07 060) FRANS CARTWRIGHT
SAN.JOSE,CA 95133
OWNER'S NAME:STEVENS CREEK VILLAGE,INC. DATE ISSUED:08/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lic.#828814 X BLDG—ELECT X PLUMB
Contractor FRANS CARTWRIGHT Date 12/31/2019 —
I hereby affirm that I am licensed ander the provisions of Chapter 9(commencing —
MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE 40 GAL WATER HEATER SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have not will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,forthe
performance of the work for which this permit is issued.
I, I have and will maintain Worker's Compensation Insurance,as provided for by
issued. Sq.Ft Floor Area: Valuation:$1799.00
APPLICANT CERTDzICAT[ON
1 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 375 07 060
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 saidun consequence of the granting this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all ll non-point
source reg I tlo s per Cupertin Municipal code,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur / Date 8-9-2018 Issued by:Kim Dimes
Date:08/09/2018
NER-
I hereby affirm that I am exempt train the Coutrnetor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be Inspected in to any roofing material being installed.If a roof Is
h. I,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,1 agree to remove al I new materials fen
compensation,will do the work,and the structure is not intended or offered for inspection.
.to(Sec.7044,Business&Professions Code)
a. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
oanhaoters to construct the project(Sec.7044,Business&Professions Code). Date:8-9-2018
1 hereby affirm Under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
a. 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 slid will maintain Worker's Compensation hnsurauce,as provided for by I have read the hazardous materials requirements nndm•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 25534.1 will
permit is issued. maintain compliance with the Cupertino 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(n)should I store or handle lia.rdous
shall not employ any person in any manner so as to become subject to the mdcrial.Additionally,should 1 use.equipment or devices which emit hazardous
air contaminants as dented by the Bay Arca A+C.dcImpte,
ment District I
Worker's Compensation laws of California.If,ager making this certificate of will maintain compliance with the C m•tino hapten 9.12 and
exemption,I become subject to the Worker's Compensation previsions ofthe the health&Safety Cod,
Icorrect.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lenthe 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 ARCFl1TEC PS DECLARATION
Code,Section 9.18, 1 understand my plans shall be used as public records.
Signature Date 8-9-2018 Licensed
Professional