B-2018-1339 CITY OF CUPERTINO BUILDING PERMIT
.BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1339
1142 DERBYSHIRE DR CUPERTINO, CA 95014-5072 (362 21 027) ELS HOME
BUILDERS INC
SAN JOSE, CA 95118
OWNER'S NAME: DATE ISSUED: 10/26/2018
OWNER'S PHONE: PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #1017251
Contractor E L'S HOME BUILDERS INC Date 08/31/2020 X BLDG — 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:
INCREASE THE PLATE HEIGHT IN GARAGE/LAUNDRY/STORAGE
I hereby affirm under penalty of perjury one of the following two declarations: (535 SF) & BUILD NEW ROOF WITH ATTIC SPACE.
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 REV #1 - FRAME LEDGER IN GARAGE CEILING - ISSUED 10/26/18
performance of the work for which this permit_iss IS _edz--•--•—
2. I have and will maintain Worker's Compensa',�o1� '�nsurance;asp. ov� or by
Section 3700 of the Labor Code, .for the e br which h"
permit is issued. � �• �"
p- � Sq. Ft Floor Area Valuation: $75000.00
APPLICANT CE FICATION
I certify that I have read this application and sfi "t`erthwrt'he above
information is correct. I agree to 362 comply with all city and county ordinances Number: Occupancy Type:
and state laws relating to building construction, and hereby authorize 362 21 027
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. WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
1<
Si natur Date •
g � � � L� � Issued by. Ph.uong.Devrles
Date: 10/26/2018
OWNER-BUILDER DECLARA IO
I hereby affirm that I am exempt from the Contr ctor'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 emplo ees 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 tructure is not intended or offered for inspection.
sale(See.7044, Business & Professions ode)
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:
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(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to,become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California If, after making this certificate of will maintain compliance with the Cupertino Mun�ipal Code, Chapter 9.12 and
exemption, I become subject to the Workers Compensation provisions of the the Health & Safety
Labor Code, I must forthwith comply with such provisions or this permit shall ----
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date: ( f
I certify that I have read this application and state that the above information is
` ONSTRUCTI N LENDI ENCY
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 Licensed
Professional