BLD-2019-1347BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 7508 KIRWIN LN Cupertino
APN: 359 23 004
PERMIT NO: BLD-2019-1347
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 5/14/2020 12:13:14 PM
ISSUED BY:
VALUATION: $60000
JOB DESCRIPTION
OTHER (207 SF); UPGRADE MAIN PANEL (200 AMP); LEGALIZE OUTSIDE KITCHEN UNDER COVERED PORCH (475 SF).
ADDITION (223 SF); REMODEL
OWNER -BUILDER DECLARATION
one of the following two
my employees with wages
exclusively contracting with
one of the following two
of consent to self -insure
Compensation Insurance,
of the work for which this
after making this certificate
shall be deemed revoked.
declarations:
as their role compensation, will do the work, and the structure
licensed contractors to construct the project (Sec.
is not intended or offered for sale (Sec. 7044. Business
I hereby
affirm under penatly
I, as owner of the property,
Code).
of perjury
or
am
of perjury
a certificate
Worker's
If,
or this permit
le
& Professions
7044, Business & Professions Code).
I, as owner of the property,
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
I hereby
declarations:
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
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
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
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 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
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 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
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
Yes
affirm
under penalty of perjury
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
representatives of this city
liabilities, judgements,
comply with all non -point
.