B-2018-0973CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0973
10314 MIRA VISTA RD CUPERTINO, CA 95014-2745 (357 02 022)
MAINE ELECTRIC INC
LIVERMORE, CA 94551
OWNER'S NAME:
DATE ISSUED: 06/07/2018
OWNER'S PHONE:
PHONE NO: (925) 443-3377
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ELECTRICAL Lic. #830250
Contractor MAINE ELECTRIC INC Date 04/30/2019
X BLDG X ELECT —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:
INSTALL DEDICATED CIRCUITS (3); OUTLETS (2); REWIRE
I hereby affirm under penalty of perjury one of the following two declarations:
OUTLETS(7)
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.
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 Floor Area:
Valuation: $6877.10 '
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
357 02 022
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 this permit.
Additionally, the applicant understands and will comply with all ll non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per toet4ertino Municipal Code, Section 9.1 B.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/07/2018
Issued by: Kim Dunbar
R DECLARATION
Date: 06/07/2018
I hereb ffirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
foil ng two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. 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)
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: 06/07/2018
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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
z. 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 o v es which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area r Qua y Management District 1
will maintain compliance with th gal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & S Cod a ons 2550 , 2553 34.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or author' ed agent•
APPLICANT CERTIFICATION
Date: 0 /0 01
I certify that I have read this application and state that the above information is
N Y
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there ip� ons ruction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this it 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 06/07/2018
Licensed
Professional