B-2018-0530 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0530
10511 CASTINE AVE CUPERTINO,CA 95014-1310(326 44 038) ROYAL POOLS OF
SANTA CLARA
SAN JOSE,CA 95124
OWNER'S NAME: ROY TAPAS K AND PALIT MADHUMANTI DATE ISSUED:03/30/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-53 Lic.#278052
Contractor ROYAL POOLS OF SANTA CLARA Date 12/31/2018 X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing 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:
(N)SWIMMING POOL(200 S.F.)
I hereb a 1rm under penalty of perjury one of the following two declarations: REV#I REPLACE EXISTING GAS LINE FOR POOL HEATER-
1. have and will maintain a certificate of consent to self-insure for Worker's ISSUED 09/05/2018
ompensation,as provided for by Section 3700 of the Labor Code,for the
erformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$54000.00
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 326 44 038
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) ee to save indemnify and keep harmless the
City of Cupertino against I' bil ies,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agai4saiditynsequence of the grantin of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ands a i ply w II non-point
source regulationo ip ode, on 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature : ,`.gate 09/05/2018 Issued by:Abby Avende
Date:03/30/2018
DECLARATION
I herebyfirm 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. 1,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)
z. 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:09/05/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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(x)shii
ld store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipmeor vices which emit hazardous
air contaminants as defined by the Bay Are'.
re r ality M nagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupert' o M icipal o ,C ter 9.12
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec ons 505,25 3 a 2 34.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:09/05/2018
1 certify that I have read this application and state that the above information is TION LEND/C
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a 96nstruction lefiding agency for a performance
relating to building construction,and hereby authorize representatives of this city ot work's tor which this perm/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 09/05/2018
Professional