BLD-2020-0019BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20090 RODRIGUES AVE APT I CUPERTINO
APN:
369 03 008
PERMIT NO: BLD-2020-0019
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 1 /2/2020 3:16:36 PM
ISSUED BY: JARCHBOLD
VALUATION: $26854.00
JOB DESCRIPTION
Apartment: UNIT D "CLARION" - Remodel Bath (212 S.F.); Remodel Kitchen (101 S.F.); Remodel Other (35 S.F.); New Lights (7 Total); New
Coil System. Floor plans are on Master Permit Number B-2017-1522.
THE BILTMORE APARTMENT - Remodel
Outlets (7 Total) ; New Condenser/Fan
OWNER -BUILDER DECLARATION
one of the following two declarations:
my employees with wages as their role compensation,
exclusively contracting with licensed contractors
one of the following two declarations:
of consent to self -insure for Worker's
Compensation Insurance, as provided
of the work for which this permit is issued,
after making this certificate of exemption,
permit shall be deemed revoked.
will do the work, and the structure
to construct the project (Sec. 7044.
is not intended or offered for sale (Sec. 7044, Business
I hereby
affirm under penatly of perjury
I, as owner of the property, or
Code).
& Professions
Business & Professions Code).
V
I, as owner of the property, am
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California. If,
with such provisions or this
I hereby
Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I shall not employ any person in any manner so as to become subject to the Worker's
I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter 6.95 of
& Safety Code,
as defined by
Sections 25505,
for this project.
the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municioal Code. Chatter 9.12 and the Health
V
with
equipment
Municipal
Section 25532(a) should I store or handle hazardous material. Additionally, should I use
the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25533, and 25534.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
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
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
and state that the above
representatives of this city to
liabilities, judgements, costs,
comply with all non -point source
information
enter upon the
and expenses
regulations
.