B-2018-1377 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1377
21901 OAKNOLL CT CUPERTINO,CA 95014-1110(326 39 014) BOB ZAMARONI
SUNNYVALE,CA
94087
OWNER'S NAME: DATE ISSUED:08/14/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION - BUILDING PERMIT INFO:
License Class PLUMBING Lia#$1@]72
Contractor BOB ZAMARONI Date 03/3112019 X BLDG ELECT X PLUMB
1 hereby affirm that I am licensed under the provisions o1'Chupfm•9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Dlvision 3 ol'the Business&Professions Code and that my
license is In full farce and effect. JOB DESCRIPTION:
REPLACE SEWER MAIN
I hereby affirm under penally of perjury one of the 1'ollowing two deelaratiuns:
haw and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Lxbor Code,for the performance o£the work for which this
permit is issued. Sq.Ft Floor Arca: Valuation:$4000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcetlon 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 326 39 014
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 IIP WORK IS NOT STARTED
may accrue against said City In consequence of the granting of this permit. WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations perihe CuperthnrMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
II c
Signature Date^f� O Issued by:Jasmine Archbold
Date:08/14/2018
3 DECLAR TIO
I hereby nfBrnr t I am exempt the Contractor's License Law far one of the RE-ROOFS:
following two reasnrs: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,w.ill do the work,and the structure is not intended or offered for inspection.
sale(Sec,7044,Business&Professioes Code)
z 1,as owner of property,am exclusively contracting with licensed Signature ofApplicaae
contractors to construct the project(Sec.7044,Business&Professions Code). Date:
I hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 have and will maintain.Certificate of Consent to self-insure For Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of tlme work£orwhich this permit is issued HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided far by 1 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for vihich this California Health&Safety Code,Sections 25505,25533,mrd 25534.1 will
permit is issuedm aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the wink for which this permit is issued,I health&Safety Code,Section 25532(.)should I stare or handle hazardous
shall not employ my person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,atter making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 255 25533,and 25534.
Labor Code,I umst forthwith comply with such provisions or this permit shall
be deemed revoked. .Owner or authorized agent:
APPLICANT CERTIFICATION Data;
I certify that I have read this application and state that the above information is CONSTRU O LED EN.Y
correct.I agree to comply with all city and county ordinances and state laws hereby affirm that there Is a onstructmn Iendin gency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit issued(Sec. 7,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 ARCH11'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureDate Licensed
Professional