B-2019-0562 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0562
20200 LUCILLE AVE APT 75 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
X MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
VERANDA UNIT#75-RE-PIPE ENTIRE UNIT(8 FIXTURES);
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE(3)WINDOWS AND(1)SLIDER;(N) 100 AMP SUB-PANEL;
1. I have and will maintain a certificate of consent to self-insure for Worker's KITCHEN REMODEL(88 SF);BATHROOM REMODEL(165 SF);
Compensation,as provided for by Section 3700 of the Labor Code,for the REMODEL OTHER(122 SF);(N)LED LIGHTING(15 TOTAL);(N)
performance of the work for which this permit is issued. FURNACE AND A/C UNITS
Section 3700 of the Labor Code for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$25000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above APN
information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type:
316
and state laws relating to building construction,and hereby authorize 316 02 094
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
Additionall -
Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature _ ` Date 4-3-2019 Issued by:Kim Dunbar
Date:04/03/2019
OWNER-BUDDER 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. 1,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
perfonnance 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I
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 compliancehehe
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a` :n�struction 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
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 4-3-2019 Professional