15110051CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110051
10104 BYRNE AVE CUPERTINO CA 95014 (357 16 044) KRIS CONSTRUCTION
FREMONT. CA 94538
OWNER'S NAME: SILAWATCHARAPOL SIRILAK AND YERGERA
OWNER'S PHONE: (
LICENSED CONTRACTOR'S DECLARATION
License Class @ Lic. #933524
Contractor KRIS CONSTRUCTION Date 06/30/2019
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.
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
DATE ISSUED: 05/05/2016
PHONE NO: (
BUILDING PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH _ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
CONSTRUCT (N) 2 STORY SFD (3,294 S.F.); COVERED
PORCH (120 S.F.) WITH ATTACHED GARAGE (442 S.F.)
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: $576000.00
APPLICANT CERTIFICATION
I 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
and state laws relating to building construction, and hereby authorize
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the a)arplicant understands and will comply with all non -point
source regulatigr(s per the Cupertino Municipal Code, Section 9.18.
Signature Date 6/8/2917
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
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:
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.
I 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
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I 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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 6/8/2017
APN Number: Occupancy Type:
357 16 162
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
R&ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Al
Date: 6/8/2017
ALL ROOF COVERINGS TO BE CLASS "A"
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Quality Management District I
will maintain compliance with the Cuperti Municipal Code, Chapter 9.12 and
the Health & Safety Code, Se5plIns 25505, 25533, and 25534.
Owner or authorized agent:
Date: 6/8/2017
CON TRUC�ON LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110051
10104 BYRNE AVE CUPERTINO CA 95014 (357 16 044) KRIS CONSTRUCTION
FREMONT, CA 94538
OWNER'S NAME: DATE ISSUED: 05/05/2016
OWNER'S PHONE: ( PHONE NO: (408) 835-6620
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class b Lic. #933524
Contractor KRIS CONSTRUCTION Date 06/30/2019 _ BLDG _ ELECT — PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing —
MECH _ 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:
CONSTRUCT (N) 2 STORY SFD (3,294 S.F.); COVERED
I hereby affirm under penalty of perjury one of the following two declarations: PORCH (120 S.F.) WITH ATTACHED GARAGE (442 S.F.)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 - MOVE WALL BETWEEN KITCHEN AND MUDROOM,
Compensation, as provided,for by Section 3700 of the Labor Code, for the CHANGE (2) WINDOWS; CHANGE BATHROOM #2 LAYOUT-
performance
AYOUTperformance of the work for which this permit is issued. ISSUED 12/19/2017
2. I have and will maintain Worker's Compensation Insurance, as provided for by REV #2 - CHANGE CLOSET BEHIND GARAGE; CHANGE MUD
Section 3700 of the Labor Code, for the performance of the work for which this ROOM SINK; CHANGE BATHROOMS - ISSUED 12/10/18
permit is issued.
Sq. Ft Floor Area: Valuation: $576000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction, and hereby authorize 357 16 162
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 I
may accrue against said 9,ity in, consequence of the granting of this permit. SNOT STARTED
Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations
Issued by: Phuong Devries
Date: 05/05/2016
OWNER-BUILDER DECLARATION
I hereby 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 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)
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: 12/10/18
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
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
shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation.provisions of the will maintain compliance with the Cupert'�no Municipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Se ions 2 O5, 25533, and 25534.
be deemed revoked. ''
Owner or authorized agent:
APPLICANT CERTIFICATION Date: 12/10/18
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 12/10/18 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15110051
10104 BYRNE AVE CUPERTINO CA 95014(357 16 044) KRIS CONSTRUCTION
FREMONT,CA 94538
OWNER'S NAME: DATE ISSUED:05/05/2016
OWNER'S PHONE:( PHONE NO:(408)835-6620
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO.
License Class B Lic.#933524
Contractor KRIS CONSTRUCTION Date 06/30/2019 BLDG ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH_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
CONSTRUCT(N)2 STORY SFD(3,294 S.F);COVERED
I hereby affirm under penalty.of perjury one of the following two declarations: PORCH(120 S.F)WITH ATTACHED GARAGE(442 S.F)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-MOVE WALL BETWEEN KITCHEN AND MUDROOM,
Compensation,as provided for by Section 3700 of the Labor Code,for the CHANGE(2)WINDOWS;CHANGE BATHROOM#2 LAYOUT-
-performance of the work for which this permit is issued. ISSUED 12/19/2017
,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:$576000.00
APPLICANT CERTIFICATION
I 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 APN Number Occupancy Type:
and state laws relating to building construction,and hereby authorize 357 16 162
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.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature
g Date 12/19/2017 Issued by ABBYAYENDE
Date:05/05/2016
OWNER-BUILDER DECLARATION
I hereby 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
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)
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:12/19/2017
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
a. 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 Cuperf- o Municipal C•de,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,
APPLICANT CERTIFICATION Date:12/19/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AC3ENCY
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. I understand my plans shall be used as public records.
Signature Date 12/19/2017 LicenseProfessionald
CITY OF CUPERTINO BUILDING PERMIT
10104 BYRNE AVE CUPERTINO CA 95014 (357 16 044)
DBLIN
CONSTRUCTION
MENLO PARK, CA
NO 15110051
LOWNER'SNAME: I IDATE ISSUED: 05/05/2016 I
I OWNER'S PHONE: I I PHONE NO: (650) 492-1236
Class 5 Lic. #978548
or D B LIN CONSTRUCTION Date 11/30/2016
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
rith Section 7000) of Division 3 of the Business & Professions Code and that my
cense is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
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.
APPLICANT CERTIFICATION
I 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
and state laws relating to building construction, and hereby authorize
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date A,51ik
hereby affirm that I am exempt from the Contractor's License Law for one of the
ving two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
i. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
i. 1 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.
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.
I 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
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I 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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Sig
Date
PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
CONSTRUCT (N) 2 STORY SFD (3,294 S.F.); COVERED
PORCH (120 S.F.) WITH ATTACHED GARAGE (442 S.F.)
Sq. Ft Floor Area: I Valuation: $576000.00
APN Number: Occupancy Type:
357 16 044
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Phuong Devries
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of
BE CLASS "A" OR
HAZARDOUS_ MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Se ti 25505 5533, and 25534.
Owner;or;aut orized agent:
Date: (S
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110051
10104 BYRNE AVE CUPERTINO CA 95014(357 16 044) KRIS CONSTRUCTION
FREMONT,CA 94538
OWNER'S NAME: DATE ISSUED:05/05/2016
OWNER'S PHONE:( PHONE NO:(408)835-6620
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#933524
Contractor KRIS CONSTRUCTION Date 06/30/2019 —BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing _
MECH_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:
CONSTRUCT(N)2 STORY SFD(3,294 S.F.);COVERED
I hereby affirm under penalty of perjury one of the following two declarations: PORCH(120 S.F.)WITH ATTACHED GARAGE(442 S.F.)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#3-RELOCATE GAS METER FROM MAIN HOUSE TO ADU-
Compensation,as provided for by Section 3700 of the Labor Code,for the ISSUED 2-19-1.9
performance of the work for which this permit is issued. REV#1 -MOVE WALL BETWEEN KITCHEN AND MUDROOM,
I have and will maintain Worker's Compensation Insurance,as provided for by CHANGE(2)WINDOWS;CHANGE BATHROOM#2 LAYOUT-
Section
AYOUTSection 3700 of the Labor Code,for the performance of the work for which this ISSUED 12/19/2017
permit is issued. _
P REV#2 CHANGE CLOSET BEHIND GARAGE;CHANGE MUD
APPLICANT CERTIFICATION ROOM SINK;CHANGE BATHROOMS ISSUED 12/10/18
1 certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$576000.00
information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type:
inspection purposes. (We)agree to save indemnify and keep harmless the 357 16 162
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally,the appli nt understands and will comply with all non-point
source regulations r the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature Date 2-19-19 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by:Phuong Devries
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date:05/05/2016
following two reasons:
1. I,as owner of the property,or my employees with wages as their sole RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is
sale(Sec.7044,Business&Professions Code) installed without first obtaining an inspection,I agree to remove all new materials for
2. 1,as owner of the property,am exclusively contracting with licensed inspection.
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date:2-19-19
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
3. I certify that in the performance of the work for which this permit is issued,I California Health&Safety Code,Sections 25505,25533,and 25534. I will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Worker's Compensation laws of California. If,after snaking this certificate of Health&Safety Code,Section 25532(a)should I store or handle hazardous
exemption,I become subject to the Worker's Compensation provisions of the material. Additionally,should I use equipment or devices which emit hazardous
Labor Code,I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I
be deemed revoked. will maintain compliance with the CupertinQ� Municipal Code,Chapter 9.12 and
the Health&Safety Code,
/
correct.I agree to comply with all city and county ordinances and state laws Owner or authorized agent:
relating to building construction,and hereby authorize representatives of this cityDate:2-19-19r, AGENCY
to enter upon the above mentioned property for inspection purposes. (We)agree CONSTRUCTI N LENDING I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued(Sec.3097,Civ C.)
judgments,costs,and expenses which may accrue against said City in Lender's Name
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHITECT'S DECLARATION
Signature Date 2-19-19 1 understand my plans shall be used as public records.
Licensed
Professional