B-2019-0199 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0199
20050 RODRIGUES AVE APT G CUPERTINO,CA 95014-3148(369 03 008) Lake Biltmore
Apartments
1900 S.Norfolk St Suite
150 San Mateo,CA
94403
OWNER'S NAME: DATE ISSUED:01/31/2019
OWNER'S PHONE: PHONE NO:650-931-3400
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Lake Biltmore Apartments Date 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:
REMODEL APARTMENT:UNIT E"CROWN".REMODEL BATH(95
1 hereby affirm under penalty of perjury one of the following two declarations: SF);REMODEL KITCHEN(107 SF);REMODEL OTHER(74 SF);NEW
1. I have and will maintain a certificate of consent to self-insure for Worker's LIGHTS(7 TOTAL);NEW CONDENSER/FAN COIL SYSTEM.FLOOR
Compensation,as provided for by Section 3700 of the Labor Code,for the PLANS ON MASTER PERMIT NUMBER B-2017-1522
performance of the work for which this permit is issued.
z. 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:S 19814.00
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:
36903 008
and state laws relating to building construction,and hereby authorize 369
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 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date Issued by:Jasmine Archbold
Date:01/31/2019
OWNER-BUILDER DECLARATION
I hereby affirm that 1 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
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:
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
s Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,C apter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,
certify that I have read this application and state that the above information is CONSTRUCTION LENDI G AGE
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agen for th pe rmance
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 re ulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section