B-2019-0550 ITY OF
CUPERTINO
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
Wv's/ C.,UPERT!NC).ORC
OWNER'S NAME:
DATE ISSUED: 5/13/2020
ISSUED BY: haleym
VALUATION: 710,000
JOB DESCRIPTION:
FIRST FLOOR ADDITION (500 SF); SECOND FLOOR ADDITION (260 SF); (N) GARAGE (218 SF); (N) ADU (811 SF); KITCHEN REMODEL
(216 SF); BATHROOM REMODEL (200 SF); REMODEL OTHER (1866 SF); (N) DECK (137 SF); (N) PATIO (354 SF) ; (N) FRONT PORCH
(120 SF); (N) SITE RETAINING WALL (236 LF); (N) UPGRADE SEWER 4-INCHES; UPGRADE ELECTRICAL PANEL (200 AMPS); FULL
SPRINKLER HOUSE; (N) AC/ FURANCE
LICENSED CONTRACTOR'S DECLARATION:
LICENSED NO: 1011892 EXP DATE 3/31/22
9 (commencing with Section 7000) of Division 3 of the Business & Professions
CNE CONSTRUCTION INCORPORATION LICENSED CLASS: B
I hereby affirm that I am licensed under the provisions of Chapter
Cade and that my license is in full force and effect.
declarations:
to self -insure for Worker's Compensation,
for which this permit is issued.
Insurance, as provided for by Section
is issued.
for which this permit is issued, I shall not employ
laws of California. If, after making this certificate
Labor Code, I must forthwith comply with
as provided for by Section 3700 of the
I hereby affirm under penalty of perjury one of the following three
I have and will maintain a certificate of consent
Labor CoA, for the performance of the work
'/` I have and will maintain Worker's Compensation
performance of the work for which this permit
I certify that in the performance of the work
become subject to the Worker's Compensation
the Worker's Compensation provisions of the
deemed revoked.
3700 of the Labor Code, for the
any person in any manner so as to
of exemption, I become subject to
such provisions or this permit shall be
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California l i :alth
Chapter 9.12 and the Health &
& Safety
Safety Code,
air
Chapter
No:
Code, Seections 25505...3533, and 23334. I
Section 25532(a) should I store or
contaminants as defined by the Bay Area
9.12 and the Health & Safety Code,
/( I have read the hazardous materials requirements under Chapter
will maintain compliance with the Cupertino Municipal Coct_e,
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous
Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code,
Sections 25505, 25533, and 25534.
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification
•( No EPA Lead -Safe Certified Firm is required for this project.
IN
LENDING AGENCY
lending agency for the performance of the work which this permit is issued
I hereby affirm under penalty of perjury that there is a construction
(Section 3097, Civil Code).
Yes 1.No
Lender's Name:
Lender's Address: