B-2019-0697 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0697
10962 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 055)110932 SWEET I Q V CONSTRUCTION
OAK ST CUPERTINO,CA 95014-0124(326 51 052)10952 SWEET OAK ST INC
CUPERTINO,CA 95014-0124(326 51 054)10942 SWEET OAK ST CUPERTINO,CA SAN JOSE,CA 95110
95014-0124(326 51 053)110922 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51
051)11091-2-SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 050)
OWNER'S NAME: DATE ISSUED:04/24/2019
OWNER'S PHONE: PHONE NO:(408)638-5500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C-39 Lic.#963219
Contractor I Q V CONSTRUCTION INC Date 07/31/2019 X BLDG —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:
I:hereby affirm under penalty of perjury one of the following two declarations: GLENOAKS-RE-ROOF;TEAR-OFF;INSTALL SINGLE PLY PVC-(68SQ)
1. 1 have and will maintain a certificate of consent to self-insure for Worker's 10962 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 055)
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. 10932 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 052)
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 10952 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 054)
permit is issued.
APPLICANT CERTIFICATION 10942 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 053)
1 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 10922 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 05 1)
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for
1012 SWEET OAK ST CUPERTINO,CA 95014-0124(326 51 050)
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which Sq.Ft Floor Area: Valuation:$50000.00
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. APN Number: Occupancy Type:
32651 0.50
Date 04/24/2019
PERMIT EXPIRES IF WORK IS NOT STARTED
OWNER-BUILDER DECLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I hereby affirm that I am exempt from the Contractor's License Law for one of the 180 DAYS FROM LAST CALLED INSPECTION.
following two reasons:
1. 1,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 Issued by:Jasmine Archbold
sale(Sec.7044,Business&Professions Code) Date:04/24/2019
i. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). RE-ROOFS:
I hereby affirm under penalty of perjury one of the following three declarations: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I have and will maintain a Certificate of Consent to self-insure for Worker's installed without first obtaining an inspection,I agree to remove all new materials for
Compensation,as provided for by Section 3700 of the Labor Code,for the inspection.
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by Signature of Applicant:
Section 3700 of the Labor Code,for the performance of the work for which this
Date:04/24/2019 –
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued,I ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
exemption,I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the
Labor Code,I must forthwith comply with such provisions or this permit shall California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
be deemed revoked. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
APPLICANT CERTIFICATION Health&Safety Code,Section 25532(a)should I store or handle hazardous
certify that I have read this application and state that the above information is material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
correct.(agree to comply with all city and county ordinances and state laws
relating to building construction,and hereby authorize representatives of this city will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
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 Owfr or authorized agent:
consequence of the granting of this permit. Additionally,the applicant understands Date:04/24/2019
and will comply with all non-point source regulations per the Cupertino Municipal CONSTRUCTION LENDING AGENCY
Code,Section 9.18. 1 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
Signature Date 04/24/2019