B-2018-1531 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1531
19333 VALLCO PKWY CUPERTINO,CA 95014(316 20 076) BURR PLUMBING
AND PUMPING INC
SAN JOSE,CA 95125
OWNER'S NAME: Apple Inc DATE ISSUED:09/11/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class c-36.a Lic.#230349
Contractor BURR PLUMBING AND PUMPING INC Date 12/31/2018 X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
APPLE VP02-REPLACE(250')SEWER LATERAL AND INSTALL
I hereby affirm under penalty of perjury one of the following two declarations: MANHOLE
t. 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.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfonnance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$120000.00
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 316 20 076
representatives of this city to enter upon the above mentioned property for
inspection purposes. ( ve indemnify and keep harmless the
City of Cupertino ag ' st li 'i ies,'udg nts,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against aid ty in con eque a of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ap 'ca understan s an ill comply with all non-point
source regulati s r t e Cupertino Mu c' Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signat a Date 09/11/2018 Issued by:Jasmine Archbold
Date:09/11/2018
OWN I R 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:09/11/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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 Muni ' e,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)sh Id I stk
rdous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipm t or vazardous
air contaminants as defined by the Bay a it ualistrict I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cope in M icip9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, s 5 05,2
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:09/11/2018
I certify that I have read this application and state that the above information is E DI
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.
Licensed
Signature Date 09/11/2018
Professional