B-2018-1883 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1883
10313 COLBY AVE CUPERTINO, CA 95014-2421 (316 29 026) COOL'S CUSTOM
REMODELING INC
SAN JOSE, CA 95124
OWNER'S NAME: DATE ISSUED: 11/02/2018
OWNER'S PHONE: 510-673-0130 PHONE NO: (408) 353-9692
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Glass B Lic. #992779
Contractor COOL'S CUSTOM REMODELING INC Date 05/31/2020 X BLDG _ ELECT i PLUMB
MECH X RESIDENTIAL ^ COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
BATHROOM REMODEL (50 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
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.
. 2. 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: $25000,00
APPLICANT CERTIFICATION
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 Number: Occupancy Type:
316
and state laws relating to building construction, and hereby authorize 316 29 026
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 a ' st liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agai , t s id City in consequence of t,.� granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additional) th a li ant understands a d�wil om I with all non-point
Y, pp p Y p
source regulat ons p r the CupertinoIjbni al Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ,° Date 11-02-2018 Issued by: Kim Dunbar
, "' Date: 11/02/2018
OWNERA LDER DECLARATIO
I her 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 fast obtaining all 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: 11-02-2018
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 pennit 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
peniiit 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 a p ent 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 � y Ar�a Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the uperpino Municipal Code, Cha t'cr 9,12 and
exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Co , Se (ions 25505, 25533 nd 534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date: 11-02-2018 *,, °°
1 certify that I have read this application and state that the above information is CONSTIt>UCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there i �ai`construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city of works for. which this omit 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. I understand my plans shall be used as public records.
Signature Date 11-02-2018 Licensed
Professional