B-2019-1161BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS:
OWNER'S NAME: Not provided
OWNER'S PHONE: Not Provided
CONTRACTOR:
NILSENE BUILDER INC, 21060 HOMESTEAD ROAD #216 CUPERTINO
CONTRACTOR PHONE:
DATE ISSUED 11 /8/2019 2:44:26 PM
ISSUED BY: HALEYM
VALUATION: $500000
JOB DESCRIPTION
GARAGE - (435 -SF); (N) PORCH - (149 SF); (N) BALCONY - (68 SF)
CONSTRUCT 2-STORY SINGLE FAMILY DWELLING -(2828 SF); (N) ATTACHED
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
NILSENE
LICENSED
B GENERAL
LICENSED
1019073
EXP
10/31
I hereby
force
I hereby
BUILDER INC
CLASS:
BUILDING
NO:
DATE:
/2020
affirm that
and effect.
affirm under
I have and
for which this
I have and
I certify that
laws
with such
CONTRACTOR
I am licensed under the provisions of Chapter
penatiy of perjury one of the following three
will maintain a certificate of consent to self -insure
permit is issued.
will maintain Worker's Compensation Insurance,
in the performance of the work for which this permit
of California. If, after making this certificate of
provisions or this permit shall be deemed 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
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
An EPA Lead -Safe Certified Renovator will be responsible for
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
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 there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per
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.