BLD-2020-0474CITY OF
BUILDING PERMIT
CRY HALL
1030D TORRE AVENUE • C JPERTINO, CA 950I 4-3255
PHONF I(1ft777-'ii?9
CUPERTINO
BUILDING ADDRESS: IOUs w ESTATES ol4 Omparbitik a f60i14 I AMC IN 13 Ole
HERMIT NO: III-2070-0474
CONTRACTOR PHONE
DATE ISSUED: I ISSUED IV: JASMINE AkCNIOMD I VAWA1IO#t Silos* - __
DESCRIPTION: REPLACE (E) PORTABLE GENERATOR WITH A STAN ALONE GENERATOR - (20 KW); INSTALL (N) SUB -PANEL - (100
AMP) AND A SWITCH GEAR
OWNER- BUILDER DECLARATION;
reasons: y
will du the work, and the aifuctury is not
to construct the project (Sec.71344, Hueine r, &
as provided for by s . o
Section 3700 of the Labor Code, for the
not employ any perretn in any manner oo as to
this certificate of csenpbori. I become surest to
I hereby affirm that I am etempt from the Contractors License Law for one of the following two
I. all (Ieerier nt the rri',Wety. rsr '.t, er.';• I..\'.v•. v.. i.•. v...y.�. a. tlwir n,14...IWIllwtu.Miuii,
intended or Offered for sale (-•.
XI, as owner of the pep rt1, am e'iduiuve fy contracting with litter d cuntrartun
t'rcrl.,sclon Cods).
I hereby Ike following threw declarations:
affirm under penalty of perjury one of
I have and will maintain a t e'rtrcate• of Comet to self unsure kw Worker's Compensation.
l .:, : ! _ _ _ for the pertoirmars r tit the work for which this permit is issued
I have and well maintain Worker's Compensation Insurance, as provided for by
performance of the work for which this permit is Mimed.
KI certrl', that in lie perliwmance of the work kw which this permit is Itwa d. I shall
become subvert to the Worker's Compensation laws of California. If, after making
the Worker's Compensation provisions of the Labor Code. I must forthwith comply with such provisions .w this permit shall be
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
& "iiet) c .sfiL, •. 1
XI have read the hazardous matey ass requirements is under C7raptr &95 d thetat.t.ni•ia I health
will maintain compliance with the'. a j 1 : -.1. i, Mtu 1 . :2 and the Health &
handle hazardous Additionally, I -ent devices hazardous
Safety Code Secbon 25532(a) should I store or
sir contaminants re defined by the Rey Area
Chapter 9.12 and the I laaith & Safety Code,
No:
material. should UM' eslior ..r which rntit
Air Management Distract I the Cupertino Mursapal Code.
Quality will maintain compliance with
Sections 25505, 25531, and 25534.
An FJ'A lanadSafe Certified Renovator will be resprarable for the protect.
Certified Firm Name Firm Certification
No EPA Lead -Safe Certified Firm is required for this project
GiagnigingRatilitiraiMrsi
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
(Section 8177, Civil Code)
Yes ,NQJo
lenders Name
of the work which this permit is iserued
lender's Address:
APPLICATION CERTIFICATION
with all city and county ordinances and r4.ate
the above mentioned property for impaction
judgern rob, crab, and r'rpenesee which may accrue
I certify that I have reed this applicaticm and mate that the above rnlormatlo n Ii, correct I agree to comply
laws relating to building construction, and hereby authorize representatives of this city to ants upon
purposes (Wel agree to save indemnify and keep harmless the City of Cupertino against liabilities,
against said City in mire of granting of this permit Additionally, the applicant understands
regulations per the i 1.1 ' • '', '
and will comply with all non point source
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