BLD-2020-1150BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21371 MILFORD DR Cupertino
APN: 326 41 102
PERMIT NO: BLD-2020-1 150
CONTRACTOR:
MOOMAU PLUMBING, 1 177 BRANHAM LANE # 152 SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 7/30/2020 2:32:59 PM
ISSUED BY: haleym
VALUATION: $2690
JOB DESCRIPTION
HEATER TANK
REPLACE WATER
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
MOOMAU
LICENSED
C36
LICENSED
792821
EXP
08/31/2020
I hereby
force
I hereby
PLUMBING
CLASS:
PLUMBING
NO:
DATE:
affirm that I am licensed
and effect.
affirm under penatly
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 or
under the provisions of Chapter
of perjury one of the following three
a certificate of consent to self -insure
Worker's Compensation Insurance,
of the work for which this
If, after making this certificate
this permit shall be deemed revoked.
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
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I
the
have read the hazardous materials requirements under
Cupertino Municipal Code, Chatter 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.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
v
CONSTRUCTION LENDING AGENCY
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 that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
application and state that the above
representatives of this city
against liabilities, judgements,
will comply with all non -point
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify
construction,
harmless
the applicant
Signature:
days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.