BLD-2020-0545BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 814 S BLANEY AVE Cupertino
APN: 369 27 012
PERMIT NO: BLD-2020-0545
CONTRACTOR:
YELAVICH CONSTRUCTION, 1677 BLANEY AVENUE SAN JOSE
CONTRACTOR PHONE:
1-408-888-2684
DATE ISSUED 4/3/2020 9:21:00 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $1750
JOB DESCRIPTION
WIRING IN KITCHEN AREA DUE TO FIRE DAMAGE AND ELECTRIC METER RELEASE (SR-2020-00002)
COVID-EP - TERMINATE HAZARDOUS
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:
YELAVICH
LICENSED
B GENERAL
LICENSED
476339
EXP
07/31/2021
I hereby
force
I hereby
CONSTRUCTION
CLASS:
BUILDING CONTRACTOR
NO:
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the
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
following
to self
Insurance,
which
certificate
deemed
three declarations:
-insure 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
this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
revoked.
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
and the
Code,
responsible
this project.
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12
with
equipment
Municipal
Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
for 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
Firm Name:
No EPA Lead -Safe Certified Firm is required for
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
�Yes
Lender's
Name:
APPLICATION CERTIFICATION
application
against
will
and state
representatives
liabilities, judgements,
comply with all
that the
of this city
non -point
above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this
construction, and hereby authorize
harmless the City of Cupertino
the applicant understands
and
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.