BLD-2020-0999 UILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
ISSUED 8Y: KDUNBAR
PERMIT NO: BLO-2020.0999
OWNER'S PHONE: Not Provided
CONTRACTOR PHONE: I Lf Qc3 VG ci (2
VALUATION: $4111
ARIOSO APARTMENTS - BLO t; 5 - APT#5101-5309 - INSTALL SEISMIC EMERGENCY GAS VALVES ON ALL HOUSE LINES BY THE GAS METERS (27)
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: LICENSED CLASS:
PACIFIC PLUMBING &
C36 PLUMBING, A GENI
LICENSED NO:
1745976
EXP DATE:
105/31/2022
t hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 700D) of Division 3 of the Business & Professions Code and that my
license is In full force and effect.
I hereby affirm under penaffy of perjury one of the following three declarations:
i
DI have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for b Section
of the work for which this permit is issued. Y 3.7 (Iti of the Labor Code, for the performance
have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labar
permit is issued. Code, for the performance of the work for which this
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. 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 permit shall be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Cade. Sections 25505. 25533, and 25534.1 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 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 & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
Ei
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: : r
Firm Certification No:
ENo 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),
ElYes EiNo
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 Cade-, Sec lion 9.18.
Signature: