BLD-2020-0616 UILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10720 ALDERBROOK LN Cupertino
APN: 369 20 047
PERMIT NO: BLD-2020-0616
OWNER'S NAME: SANDOVAL DOLORES ANN AND HOFFMAN EDWARD OWE
OWNER'S PHONE: 4087258939
DATE ISSUED 5/12/2020 12:49:10 PM
ISSUED BY: haleym
VALUATION: $32275
JOB DESCRIPTION
KITCHEN REMODEL - (1 17 SF)
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: LICENSED CLASS: LICENSED NO: EXP DATE:
BRAJAN CONSTRUCTION INC B GENERAL BUILDING CONTRACTOR 975211 07/31/2020
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 penatly of perjury one of the following three declarations:
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.
v
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.
permit
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
shall be deemed revoked.
HAZARDOUS
MATERIALS DISCLOSURE
v
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 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
Safety
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 &
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.
Signature:
ik
.4000,00011t.I.7°1114,4
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.