B-2018-2067 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-2067
19480 RICHWOOD CT APT 2 CUPERTINO, CA 95014-3460 (375 01 009)119480 BAY EASY
RICHWOOD CT APT 3. CUPERTINO, CA 95014-3460 (375 01 009)119480 RICHWOOD CONSTRUCTION INC
CT APT 1 CUPERTINO, CA 95014-3460 (375 01 009) HAYWARD, CA 94541
OWNER'S NAME: DATE ISSUED: 12/17/2018
OWNER'S PHONE: PHONE NO; (925) 718-1054
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #971061
Contractor BAY EASY CONSTRUCTION INC Date 11/30/2020 X BLDG X ELECT — PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X 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:
UNIT # 1 - KITCHEN REMODEL - (250 SF); REMODEL (2)
I hereby affirm under penalty of perjury one of the -following two declarations: BATHROOMS - (150 SF) - REPLACE SUBPANEL - (100 AMP);
1. I have and will maintain a certificate of consent to self-insure for Worker's REPLACE & RELOCATE HVAC SYSTEM ABOVE HALLWAY AND
Compensation, as provided for by Section 3700 of the Labor Code, for the CONDENSER INSIDE YARD.
performance of the work for which this permit is issued. UNIT # 2 - KITCHEN REMODEL - (200 SF); REMODEL (2)
have and will maintain Worker's Compensation Insurance, as provided for by BATHROOMS - (150 SF) - REPLACE SUBPANEL - (100 AMP);
Section 3700 of the Labor Code, for the performance of the work for which this REPLACE & RELOCATE HVAC SYSTEM ABOVE HALLWAY AND
permit is issued. CONDENSER INSIDE YARD; REMODEL 2ND FLOOR BEDROOM
APPLICANT CERTIFICATION CLOSETS TO ADD WASHER AND DRYER (40 SQ FT); REWIRE
I certify that I have read this application and state that the above ENTIRE SECOND FLOOR.
information is correct. I agree to comply with all city and county ordinances UNIT # 3 - KITCHEN REMODEL - (250 SF); REMODEL (2)
and state laws relating to building construction, and hereby authorize BATHROOMS - (150 SF) - REPLACE SUBPANEL - (100 AMP);
representatives of this city to enter upon the above mentioned property for REPLACE & RELOCATE HVAC SYSTEM ABOVE HALLWAY AND
inspection purposes. (We) agree to save indemnify and keep harmless the CONDENSER INSIDE YARD; REMODEL 2ND FLOOR BEDROOM
City of Cupertino against Liabilities, judgments, costs, and expenses which CLOSETS TO ADD WASHER ANDDRYER 40 S FT • REWIRE
may accrue against said City in consequence of the granting of this permit. ( Q )�
Additionally, the applicant understands angl will comply with all non-point ENTIRE SECOND FLOOR; UPGRADE MAIN PANEL SAME
source regulations per the Cupertino Code, Section 9.18. LOCATION (400 AMP).
Sq, Ft Floor Area: Valuation: $107000.00
Signature ,. • Date 12-17-2018
�p APN Number: Occupancye:
OWNER-116- IJDER DECLARATION 375 01 009
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
11 I, as owner of the property, or my employees with wages as their sole PERMIT EXPIRES IF WORK IS NOT STARTED
compensation, will do the work, and the structure is not intended or offered for WITHIN 180 DAYS OF PERMIT ISSUANCE OR
sale (Sec.7044, Business & Professions Code) 180 DAYS FROM LAST CALLED INSPECTION.
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec,7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: Issued by: Kim DunbarDate: 1.2/17/2018
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. RE-ROOFS:
2. I have and will maintain Worker's Compensation. Insurance, as provided for by All roofs shall be inspected prior to any roofing material being installed. If a roof is
Section 3700 of the .Labor Code, for the performance of the work for which this installed without first obtaining an inspection, I agree to_rQi ,pve all new materials for
ion.,
permit is issued. inspect
s, 1 certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Signature of Applicant:
Worker's Compensation laws of California. If, after making this certificate of Date: 12-17-2018w�w '�"'Ay
exemption, I become subject to the Worker's Compensation provisions of the ..-..�aa� .
Labor Code, I must forthwith comply with such provisions or this permit shall ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
be deemed revoked.
APPLICANT CERTIFICATION HAZARDOUS MATERIALS DISCLOSURE
I certify that I have read this application and state that the above information is I have read the hazardous materials requirements under Chapter 6.95 of the
correct. I agree to comply with all city and county ordinances and state laws California Health & Safety Code, Sections 25505, 25533, and 25534. I will
relating to building construction, and hereby authorize representatives of this city maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
to enter upon the above mentioned property for inspection purposes. (We) agree Health & Safety Code, Section 25532(a) should I store or handle hazardous
to save indemnify and keep harmless the City of Cupertino against liabilities, material. Additionally, should I use equipment or devices which emit hazardous
judgments, costs, and expenses which may accrue against said City in air contaminants as defined by the Bay Area Air Quality Management District .1
consequence of the granting of this permit. Additionally, the applicant understands will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
and will comply with all non-point source regulations per the Cupertino Municipal the Health & Safety Code, Sections 25505, 25533, and 25534.
Code, Section 9.18.
Owner or authorized agent:
Signature Date 12-17-2018 Date: 12-17-2018
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance