B-2019-0707 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0707
7604 NEWCASTLE DR CUPERTINO,CA 95014-5265(366 17 009) A R S AMERICAN
7
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME:
DATE ISSUED:04/25/2019
PHONE NO:(901)271-9700
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36,C42,A Lic.#765155 IX BLDG ELECT X PLUMB
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MECH X RESIDENTIAL—COMMERCIAL
Date 07/31/2020 —
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 JOB DESCRIPTION: N BUILDING CLEAN-OUT
license is in full force and effect. REPLACE SEWER LINE AND INSTALL(N)
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.
�1 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 Sq.Ft Floor Area: Valuation:$12952.00
permit is issued.
APPLICANT CERTIFICATION APN Number: Occupancy Type:
certify that I have read this application and state that the above 366 17 009
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 PERMIT EXPIRES IF WORK IS NOT STARTED
i p
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
y,
A ditionall theapplicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
Additionally,
source re Code,Section 9.18.
- Issued by:Jasmine Archbold
Signature Date 04/25/2019 Date:04/25/2019
OWNER-BUILDER DECLARATION RE-ROOFS:
t from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt installed without first obtaining an inspection,I agree to remove all new materials for
following two reasons: inspection.
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) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:04/25/2019
contractors to construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
f the for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
performance of work 2. i have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
performance of the work for which this Health&Safety Code,Section 25532(a)should I store or handle hazardous
permit is issued. material. Additionally,should I use equipment or devices which emit hazardous
3. I certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with
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 Owner or authorized agent:
be deemed revoked. I Gate:04/25/2019
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
application and state that the above information is
I certify that I have read this pp 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.)
correct.I agree to comply with all city and county ordinances and state laws Lender's Name
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant understands I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18.
Licensed