B-2018-1465 t
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1465
1032 BUBB RD CUPERTINO,CA 95014-4939(362 04 019) SMH CUSTOM
CABINETRY
SANTA CLARA,CA
95050
OWNER'S NAME: SATTERLEE CANDACE K TRUSTEE DATE ISSUED:08/29/2018
OWNER'S PHONE:
LICENSED ENSEDCONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#516147
Contractor SMH CUSTOM CABINETRY Date 08/31/2019 X BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
KITCHEN REMODEL-(98 SF)-REMODEL(2)BATHROOMS
I hereby afMr der penalty of perjury one of the following two declarations: MASTER AND GUEST BATH-(90 SF)-UPGRADE MAIN PANEL-
t, a and will maintain a certificate of consent to self-insure for Worker's (200 AMP)-(N)SUBPANEL-(80 AMP)-(N)FURNACE SAME
eA pensation,as provided for by Section 3700 of the Labor Code,for the LOCATION(N)AC UNIT-BACKYARD-(N)EXT AND INTERIOR
performance of the work for which this permit is issued. LIGHTING IN GARAGE(10 TOTAL)-(8)WINDOW REPLACEMENTS
2. I have and will maintain Worker's Compensation Insurance,as provided for by LIKE FOR LIKE,REPLACE(1)SLIDING DOOR(3)INT DOORS -(N)
Section 3700 of the Labor Code,for the performance of the work for which this ATTIC INSULATION(R38)
permit is issued.
Sq.Ft Floor Area: Valuation:$125000.00
APPLICANT CERTIFICATION
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: Occupancy Type:
and state laws relating to building construction,and hereby authorize 362 04 019
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.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulat, per the Cu rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/29/2018 ued by:Jasmine Archbold
Date:08/29/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 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:08/29/2018
I hereby affirm under penalty of perjury one of the following three declarations:
r. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the Will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code Sections 25505,25533, d 25534.
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/29/2018
1 certify that I have read this application and state that the above information is CONSTRUCTION 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 Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 08/29/2018 Licensed
Professional