B-2018-1418 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1418
10910 KESTER DR CUPERTINO,CA 95014-3916(356 28 019) PANOBORN ROBERTA
JTRUSTEE
10910 RESTER DR
CUPERTINO,CA
95014-3916
OWNER'SNAME; DATE ISSUED:09/23/2018
OWNER'S PHONE; PRONE NO:None
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.If
Contractor PANGBORN ROBERTAJ TRUSTEE Date X BLDG_ELECT_PLUMB
I herebyaffirm that I am licensed uoder the _MECH X RESIDENTIAL_COMMERCIAL
provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty or perjury one of the fallowing two declarations: RETROFIT WINDOWS(6)LIKE FOR LIKE TO MEET EGRESS
u 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
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Fla.,-Area: Valuation:$5930.00
APPLICANT CERTIFICATION
I certify that I have read this applicationand slate that the above
information Is correct.I agree to comply with all city and county ordinances APN Number: Occupnc
ay Type:
and state laws relating to building construction,and hereby authorize 356 28 019
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 regulationsperthe Gupertin /aunicipalll Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature --pate 0812 Issued by:Haley McKee
Date:08/23/2018
OWNER-BUILDER DECLARAT ON
1 hereby nflirnn that I am exempt from the Contractor's License Law f.,.one.1 the RE-ROOFS,
h lowing hva rensana: All roofs shelf be inspected prior to any roofing material being installed.If a roof is
I certify that in the performance,of the work for which this permit is issued,I health&Safety Code,Section 25532(a)should l store at-handle hazardous
shell not employ an material.Additionally,should I use equipment ar devices which emit hazardous
p y y person in any rummer as to subject m the air contamimmts ns AcfineA by file Bay Area Ah-Quality Management District I
Worker's Compensation laws o£Californie.If,after making this certificate of will maintain
compliance with the Cupertino Municipal ode,Chxpter 9.12 and
exemption,I became subject to the Worker's Compensntion provisions of the the 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-points once regulations per the Cupertino Municipal ARCT'
HITECS DTCI ARAI ION
C.
08123118 Licensed