B-2019-0444 CITY OF CUPERTINO BUILDING PERMIT
BUILDLNG ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0444
10300 BYRNE AVE CUPERTINO,CA 95014-2812(357 15 124) Mendelson Felix Trustee
222 Jo Dr Los Gatos,CA
95032-2416
OWNER'S NAME: DATE ISSUED:03/14/2019
OWNER'S PHONE: PHONE NO:415-595-8331
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Mendelson Felix Trustee Date X BLDG X 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:
UPGRADE MAIN PANEL-(200 AMP)
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:$2500.00
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 Number: Occupancy Type:
357 15 124
and state laws relating to building construction,and hereby authorize 357
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 03/14/2019 Issued by:Jasmine Archbold
Date:03/14/2019
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
not employ any person in any manner so as to become subject to the air contaminants as defined by the
APPLICANT CERTIFICATION Date:03/14/2019
certify that I have read this application and state that the above information is CONSTRUC ON 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 ex enses which may accrue against said City in Lender's Address
consequence
1 understand my plans shall be used as public records.
Signature Date 03/14/2019 Licensed
Professional