BLD-2020-1001;.ti�.r� BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
W W W.CUPERTINO.ORG
PERMIT NO: 8LD-2020-100 i
ISSUED BY: KDUNBAR
OWNER'S PHONE: Not Provided
CONTRACTOR PHONE: 4088949120
VALUATION: $41 11
ARIOSO APARTMENTS - BID #7 - APT#7101-7308 - INSTALL SEISMIC EMERGENCY GAS VALVES ON ALL HOUSE LINES BY THE GAS METERS (24)
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: LICENSED CLASS:
IC36 PLUMBING, A GENT
1
PACIFIC PLUMBING & F.
EXP DATE:
05/31 /2022
hereby affirm that I arty licensed under the provisions of Chapter 9 (commencln with Section 7000 of Division 3 of the Business & Professions Code and
license Is In full force and effect. that my
I hereby affirm under penally of perjury one of the folfowfng three declarations:
LJI have and will maintain a certificate of consent to self -insure for Wor
of the work for which this permit is issued, leers Compensation, as provided for by Section 3700of the Labor Code, for the performance
ID
have and will maintain Workers Compensation insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this
ermit is issued.
I certify that in the performance of the work for which this permit is Issued, I shall not employ any
Compensation laws of California. If, after making this certificate of exemption, I become subject to the WorkersCompe Compensation provisecome subject to the Workers
ions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
LICENSED NO:
f745976
I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. twill maintain
compliance with the Cupertino lviunicipaf Code, Chapter 9.12
Additionally, should I use equipment or devices which emit hazardous air contaminants asyodedefinedtion byte Bay Area Ai25532(a)irQuality ty ManagementI store or handlerDistrict I will mat
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. main
EPA LEAD -SAFE DISCLOSURE
i
0 An EPA Lead -Safe Certified Renovator wilt be responsible for this project.
Certified Firm Name:
Firm Certification No: i
4
No 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 No
Lenders Name:;
APPLICATION CERTIFICATION
f certify that I have read this application and slate 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 Code, Section 9.18.
Signature:
•
Lender's Address:
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