BLD-2019-1040 PermitBUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10818 CARVER DR Cupertino
APN: 375 32 003
PERMIT NO: BLD-2019-1040
CONTRACTOR:
TOP BUILDER, 10750 MINETTE DR. CUPERTINO
CONTRACTOR PHONE:
408-598-0850
DATE ISSUED 7/30/2020 6:36:43 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $350000
JOB DESCRIPTION
SF); REPLACE 4" SEWER LINE; INSTALL (N) PROPERTY LINE CLEANOUT; REPLACE (E) WATER LINE.
(N) SINGLE STORY SFD (2,421 SF); (N) ATTACHED GARAGE(437
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
TOP
LICENSED
B GENERAL
LICENSED
1003446
EXP
05/31/2021
I hereby
force
I hereby
BUILDER
CLASS:
BUILDING CONTRACTOR
NO:
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall be
following
to self
Insurance,
for which
this certificate
deemed
three declarations:
-insure 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
this 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
revoked.
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
and the
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12
with
equipment
Municipal
Health & 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
responsible for this project.
Firm Certification No:
for this project.
An EPA Lead -Safe Certified Renovator will be
Firm Name:
No EPA Lead -Safe Certified Firm is required
Certified
v
CONSTRUCTION LENDING AGENCY
is a construction 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
that the
of this city
all non -point
above 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 that I
construction,
harmless the
the applicant
Signature:
have read this application and state
and hereby authorize representatives
City of Cupertino against liabilities, judgements,
understands and will comply with
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.