B-2019-0561 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0561
20200 LUCILLE AVE APT 74 CUPERTINO,CA 95014-2048(316 02 094) V&V RESTORATION
INC
ANTELOPE,CA 95843
OWNER'S NAME: DATE ISSUED:04/03/2019
OWNER'S PHONE: PHONE NO:(916)708-1678
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#908328
Contractor V&V RESTORATION INC Date 12/31/2019 X BLDG X ELECT X 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:
VERANDAS UNIT#74-PIPE ENTIRE UNIT(8 FIXTURES);REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: (3)WINDOWS AND(1)SLIDER;(N)100 AMP SUB-PANEL;KITCHEN
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL(88 SF);BATHROOM REMODEL(165 SF);REMODEL
Compensation,as provided for by Section 3700 of the Labor Code,for the OTHER(122 SF);(N)LED LIGHTING(15 TOTAL);(N)FURNACE AND
performance of the work for which this permit is issued. A/C UNITS
is issued. Sq.Ft Floor Area: Valuation:$25000.00
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 31Number: Occupancy Type:
6 02 094
and state laws relating to building construction,and hereby authorize 316
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
D ate 4-3-2019 Issued by:Kim Dunbar
Date:04/03/2019
OWNER-BUILDU DEACLARATION
I herebyaffirm tlia I am exempt from the Contractor's License Law for one of the RE-ROOFS:
p All roofs shall be inspected prior to an roofing material being Installed.If a roof is
following two reasons: P .p y g g
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)
z. 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:4-3-2019
1 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
i. 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
pernut 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 equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as
APPLICANT CERTIFICATION Date:4-3-2019
certify that I have read this application and state that the above information is CON TRU ION LENDI G AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of works 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.
Licensed
Signature Date 4-3-2019 Professional