B-2019-0743 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0743
20200 LUCILLE AVE APT 28 CUPERTINO,CA 95014-2043(316 02 094)120200 MIRANDA
LUCILLE AVE APT 27 CUPERTINO,CA 95014-2043(316 02 094)120200 LUCILLE ELECTRICAL SERVICE
AVE APT 26 CUPERTINO,CA 95014-2043(316 02 094)120200 LUCILLE AVE APT 25 INC
CUPERTINO,CA 95014-2043(316 02 094)20200 LUCILLE AVE APT 24 CUPERTINO, SAN JOSE,CA 95127
CA 95014-2043(316 02 094)120200 LUCILLE AVE APT 23 CUPERTINO,CA 95014-
2043(316 02 094)120200 LUCILLE AVE APT 22 CUPERTINO,CA 95014-2043(316 02
094)120200 LUCILLE AVE APT 21 CUPERTINO,CA 95014-2043(316 02 094)120200
LUCILLE AVE APT 20 CUPERTINO,CA 95014-2043(316 02 094)20200 LUCILLE
AVE APT 19 CUPERTINO,CA 95014-2043(316 02 094)20200 LUCILLE AVE APT 18
CUPERTINO,CA 95014-2043(316 02 094)X20200 LUCILLE AVE APT 17 CUPERTINO,
CA 95014-2043(316 02 094)
OWNER'S NAME: DATE ISSUED:05/16/2019
OWNER'S PHONE: PHONE NO:(408)829-5863
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#860767
Contractor MIRANDA ELECTRICAL SERVICE INC Date 06/30/2019 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:
VERANDAS-BUILDING 6 UNITS 17 THROUGH UNITS 28 -PANEL
I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE SAME LOCATION(600 AMP);TRENCHING ON PRIVATE
1. I have and will maintain a certificate of consent to self-insure for Worker's PROPERTY;MASTER PLAN B-2018-1406
have and will maintain Worker's Compensation Insurance asprovided 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:$12000.00
APPLICANT CERTIFICATION
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 16 Number: Occupancy Type:
3
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
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 05/16/2019 Issued by:Jasmine Archbold
Date:05/16/2019
OWNER-BUILDER 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. 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)
2. 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:05/16/2019
I 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
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
permit 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 defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,
�.
APPLICANT CERTIFICATION Date:05/16/2019
I certify that I have read this application and state that the above information is CONSTRUCTION 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,
Lender's Address