B-2019-0873 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0873
7577 HEATHERWOOD DR CUPERTINO,CA 95014-5840(359 26 058) BAY AREA DESIGN&
CONSTRUCTION
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:07/17/2019
OWNER'S PHONE: PHONE NO:(408)209-8942
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#22A1
Contractor BAY AREA DESIGN&CONSTRUCTION Date 10/31/2020 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:
(N)REAR ADDITION(3 70 SF);(N)FRONT ADDITION(77 SF);
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL BATHROOMS(274 SF TOTAL);REMODEL
1. ,J have and will maintain a certificate of consent to self-insure for Worker's KITCHEN(213 SF);REMODEL OTHER(1,198 SF);RELOCATE
` Compensation,as provided for by Section 3700 of the Labor Code,for the FURNACE TO ATTIC;(N)A/C UNIT;(N)TANKLESS WATER
performance of the work for which this permit is issued. HEATER;FULLY SPRINKLER BLDG;(N)FRONT PORCH(27 SF);
2. have and will maintain Worker's Compensation Insurance,as provided for by (N)EV CHARGER
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area:447 Valuation:$250000.00
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 APN Number:
and state laws relating to building construction,and hereby authorize Occupancy Type.
359 26 058 R-3(Custom)
representatives of this city to enter upon the above mentioned property for
inspection purposes,-( e)agree to save indemnify and keep harmless the
Cit of Cupertino a ain�t liabilities judgments,
costs and expenses which
may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source
Date:07/17/2019
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
1. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
compensation,will do the work,and the structure is not intended or offered for
installed without first obtaining an inspection,I agree to remove all new materials for sale(Sec.7044,Business&Professions Code) inspection.
2. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant:
Date:07/17/2019
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 2505,25533,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)show_-I'd I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equit,�``-meat or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined b the Ba Area'Air Quality Management District I
Y Y/ , Q t3' g
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with2Code,
ertno Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health& 25534.
be deemed revoked.APPLICANT CERTIFICATION Owner or authorized ageni
I certify that I have read this application and state that the above information is Date:07/17/2019
correct.I agree to comply with all city and county ordinances and state laws CONSTRUI'ION LENDING AGENCY
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
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
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. 1 understand my plans shall be used as public records.
Signature Date 07/17/2019 Licensed
Professional