BLD-2019-1334BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20200 LUCILLE AVE APT 89 CUPERTINO
APN: 316 02 094
PERMIT NO: BLD-2019-1334
CONTRACTOR:
PACIFIC PLUMBING & SEWER SERVICE INC, 329 SANGO CT MILPITAS
CONTRACTOR PHONE:
DATE ISSUED 11 /7/2019 3:00:38 PM
ISSUED BY: JARCHBOLD
VALUATION: $1200
JOB DESCRIPTION
HEATER - SAME LOCATION
(N) 40 GALLON WATER
LICENSED CONTRACTOR DECLARATION
B GENERAL
provisions of
of the following
of consent to
Insurance,
work for which
making this certificate
shall be deemed
BUILDING CONTRACTOR
Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
PACIFIC
LICENSED
C36
LICENSED
745976
EXP
05/31/2020
I hereby
force
I hereby
PLUMBING & SEWER SERVICE INC
CLASS:
PLUMBING, A GENERAL ENGINEERING CONTRACTOR,
NO:
DATE:
affirm that I am licensed under the
and effect.
affirm under penatiy of perjury one
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the
laws of California. If, after
with such provisions or this permit
three
self -insure
this
revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
9.12 and the
Health
Code,
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
for this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that
No
V
Lender's
Name:
APPLICATION CERTIFICATION
application and
representatives
against liabilities,
will comply
1 juip
issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.