B-2019-1204BUILDING 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:
ANTONIO ALVARADO PENALOZA, 3459 MARTEN AVE SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 2/20/2020 10:17:19 AM
ISSUED BY: HALEYM
VALUATION: $40000
JOB DESCRIPTION
THE FOLLOWING: FIRST FLOOR- REMOVE (E) FIREPLACE, AND PROVIDE (N) CLOSET AND PANTRY (47 SF);
ENTRY DOOR AND (1) WINDOW REV #1 - (N) SUB -PANEL (100 AMP) ; (N) BEAM PER FIELD CONDITION -
KITCHEN REMODEL - (175 SF); REMODEL OTHER (86 SF) - ENCOMPASSING
SECOND FLOOR - REMOVE CHIMNEY AND PROVIDE (N) CLOSET; REPLACE
ISSUED 2/20/20
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
ANTONIO
LICENSED
B GENERAL
LICENSED
791190
EXP
02/28/2021
I hereby
force
I hereby
ALVARADO
CLASS:
BUILDING
NO:
DATE:
affirm
and effect.
affirm
I have and
for which
I have and
I certify that
with
PENALOZA
CONTRACTOR
that I am licensed under the provisions of Chapter
under penatly of perjury one of the following three declarations:
will maintain a certificate of consent to self -insure for Worker's
this permit is issued.
will maintain Worker's Compensation Insurance, as provided
in the performance of the work for which this permit is issued,
laws of California. If, after making this certificate of exemption,
such provisions or this permit shall be deemed revoked.
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
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
6.95
& Safety
defined
25505,
this project.
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
Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
by 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 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
enter upon
: