BLD-2020-0437CITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10160 MELLO PL, Cupertino, CA 95014-3336 APN: 369 05 025
PERMIT NO: BLD-2020-0437
:
DATE ISSUED: 6/1/2020 ISSUED BY: PhuongD VALUATION: $70,000
JOB DESCRIPTION: REMODEL BATHROOMS (120 SF); REMODEL KITCHEN (270 SF); REMODEL OTHER (300
SF); RELOCATE FURNACE TO ATTIC; ADD A/C; ELECTRICAL UPGRADES OF
NON -REMODELED AREA (750 SF).
OWNER -BUILDER DECLARATION:
reasons:
will do the work, and the structure is not
to construct the project (Sec.7044, Business &
as provided for by Section 3700 of the
I hereby affirm that I am exempt from the Contractor's License Law for one of the following two
I I, as owner of the property, or my employees with wages as their role compensation,
intended or offered for sale (Sec. 7044, Business & Professions Code).
I, as owner of the property, am exclusively contracting with licensed contractors
Profession Code).
I hereby affirm under penalty of perjury one of the following three declarations:
I I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation,
Labor Code, for the performance of the work for which this permit is issued.
Section 3700 of the Labor Code, for the
not employ any person in any manner so as to
this certificate of exemption, I become subj ect to
with such provisions or this permit shall be
I I have and will maintain Worker's Compensation Insurance, as provided for by
performance of the work for which this permit is issued.
L I certify that in the performance of the work for which this permit is issued, I shall
become subject to the Worker's Compensation laws of California. If, after making
the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I
I have read the hazardous materials requirements under Chapter 6.95 of the California Health
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or
air contaminants as defined by the Bay Area
Chapter 9.12 and the Health & Safety Code,
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,
Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
No:
I An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification
r No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
(Section 8172, Civil Code).
I Yes ®'No
Lender's Name: Lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and state
the above mentioned property for inspection
judgements, costs, and expenses which may accrue
and will comply with all non -point source
I certify that I have read this application and state that the above information is correct. I agree to comply
laws relating to building construction, and hereby authorize representatives of this city to enter upon
purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities,
.