BLD-2020-0216BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10520 S DE ANZA BLVD Cupertino
APN: 369 39 017
PERMIT NO: BLD-2020-0216
CONTRACTOR:
Y B CONSTRUCTION, 10410 CALVERT DR CUPERTINO
CONTRACTOR PHONE:
DATE ISSUED 2/3/2020 10:1 1:41 AM
ISSUED BY: HALEYM
VALUATION: $2900
JOB DESCRIPTION
I
VONS CHICKEN - INSTALL (2) LED WALL
SIGNS
LICENSED CONTRACTOR DECLARATION
CONTRACTOR:
Y B CONSTRUCTION
LICENSED CLASS:
B GENERAL BUILDING CONTRACTOR, CI ELECTRICAL
LICENSED NO:
895649
EXP DATE:
05/31/2021
I hereby affirm that I am licensed under the
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
force and effect.
I hereby
affirm under penatiy of perjury one of the following three declarations:
V
I have and will maintain a certificate of consent to self -insure
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
Compensation
laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials
requirements under
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
V
with
the Cupertino Municipal Code, Chapter 9.12 and the Health
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
equipment
or devices which emit hazardous air contaminants
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Municipal
Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified
Firm Name:
Firm Certification No:
v
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby
affirm
under penalty of perjury
that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes
V
No
Lender's
Name:
Lender's Address:
APPLICATION CERTIFICATION
I certify that I have read this application
and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgements, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
\
Every 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
of 365 days after the time the work is commenced.