BLD-2020-0639BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 885 LONNA LN Cupertino
APN: 359 19 031
PERMIT NO: BLD-2020-0639
CONTRACTOR:
P D 0 ELECTRICAL SERVICES, 3090 LOS PRADOS STREET #8 SAN MATEO
CONTRACTOR PHONE:
DATE ISSUED 5/14/2020 1:52:39 PM
ISSUED BY: KDUNBAR
VALUATION: $1500
I
JOB DESCRIPTION
AMP) SAME LOCATION
PANEL UPGRADE (200
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
P D 0
LICENSED
C10
LICENSED
987182
EXP
09/30/2021
I hereby
force
I hereby
ELECTRICAL SERVICES
CLASS:
ELECTRICAL
NO:
DATE:
affirm that I am licensed
and effect.
affirm under penatiy
I have and will maintain
for which this permit is issued.
I have and will maintain
I certify that in the performance
laws of California.
with such provisions
under the provisions of Chapter
of perjury one of the following three
a certificate of consent to self -insure
Worker's Compensation Insurance, as
of the work for which this permit
If, after making this certificate of
or this permit shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter
as
Sections
for
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
An EPA Lead -Safe Certified Renovator will be responsible
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
application and state that the above
representatives of this city to enter
against liabilities, judgements, costs,
will comply with all non -point source
.—
I
the
have
and hereby
City of
understands
read this
authorize
Cupertino
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.