B-2019-0480BUILDING 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:
ALI'S CONSTRUCTION & REMODELING INC, 1011 S DE ANZA BLVD SAN JOSE
CONTRACTOR PHONE:
4087714358
DATE ISSUED 11 /26/2019 2:20:54 PM
ISSUED BY: KDUNBAR
VALUATION: $0
JOB DESCRIPTION
INSTALL OSB; COMP SHINGLES (31 SQ); (N) FURNACE; (N) A/C REV #1 - UPGRADE ELECTRICAL PANEL (200 AMP) -
THE EXISTING FURNACE TO REMAIN IN THE SAME -LOCATION: ADD (N) FURNACE (IN ATTIC) AND (N) AC UNIT (SIDE
ADDITION (830 SF); COVERED PORCH (45 SF); RE -ROOF TEAR -OFF;
ISSUED 10/16/19 REV # 2 - REVISE TO FIELD CONDITIONS SHOWING
YARD) TO SERVE THE NEW ADDITION -ISSUED 11/26/2019
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
ALI'S
LICENSED
B GENERAL
LICENSED
909433
EXP
01/31/2020
I hereby
force
I hereby
CONSTRUCTION
CLASS:
BUILDING
NO:
DATE:
affirm
and effect.
affirm
I have and
for which
I have and
I certify that
with
& REMODELING INC
CONTRACTOR
that I am licensed under the provisions of Chapter
under penatly of perjury one of the following three
will maintain a certificate of consent to self -insure
this permit is issued.
will maintain Worker's Compensation Insurance,
in the performance of the work for which this permit
laws of California. If, after making this certificate of
such 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
: