B-2019-0338BUILDING 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:
GOMEZ CONSTRUCTION, 23 S 19TH STREET SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 1/16/2020 1 1:39:31 AM
ISSUED BY: HALEYM
VALUATION: $33000
JOB DESCRIPTION
INTO AN ADDITIONAL BEDROOM AND BATHROOM (320 SF); TO BE SERVED BY (N) ELECTRIC TANKLESS WATER HEATER; (N) HEAT PUMP;
1 - REMOVE A WALL; LABEL FRIDGE IN KITCHEN; MOVE ELECTRIC WATER HEATER TO BATHROOM -ALL ON SHEET A2 - ISSUED 1 /16/2020
CONVERT/REMODEL SINGLE CAR GARAGE
UPGRADE SUB -PANEL (200 AMP) REV #
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
GOMEZ
LICENSED
B GENERAL
LICENSED
782581
EXP
08/31/2020
I hereby
force
I hereby
CONSTRUCTION
CLASS:
BUILDING CONTRACTOR, C-8 CONCRETE
NO:
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the following
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work for
laws of California. If, after making this
with such provisions or this permit shall be deemed
three
to self -insure
Insurance,
which this permit
certificate of
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
requirements
9.12 and
under Chapter
the Health
as
Code, Sections
for
project.
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
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
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
Certified
V
CONSTRUCTION LENDING AGENCY
that 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
affirm
under penalty of perjury
No
�YesV
Lender's
Name:
APPLICATION CERTIFICATION
and state that
of
liabilities,
permit 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