B-2018-1722CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-1722
6387 MYRTLEWOOD DR CUPERTINO, CA 95014-4624 (369 17 005)
ALLSTAR PLUMBING
CORPORATION
SAN JOSE, CA 95112
OWNER'S NAME: HENELL ROBERT C AND JANICE L TRUSTEE
DATE ISSUED: 10/10/2018
OWNER'S PHONE:
PHONE NO: (408) 282-7020
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C_36 Lic. #732611
Contractor ALLSTAR PLUMBING CORPORATION Date 02/28/2019
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 Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
KITCHEN DRAIN REPLACEMENT (UNDER HOUSE)
I hereby affirm under penalty of perjury one of the following two declarations:
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 Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
�2.
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $2000.00
permit is issued.
APPLICANT CERTIFICATION
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 state laws relating to building construction, and hereby authorize
369 17 005
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 ip sequence of the granting of this permit.
Additionally, the applicant yne tands and ill comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations
18
Issued by: Haley McKee
"
Date: 10/10/2018
hereb ffirm that I am exempt from the C_ogtraetbr s License Law for one of the
RE -ROOFS:
fo two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
m. 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 the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 10/10/18
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I 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 which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 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 hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment r devices which emit hazardous
air contaminants as defined by the Bay AreQuality Management District I
Worker's Compensation laws of California. If, ager making this certificate of
will maintain compliance with the Cupertino Municipal 0 e, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
relating to building construction, and hereby authorize representatives of this city
of work's for which this pe itis 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
ARCHIT'
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 10/19/18
Licensed
Professional