BLD-2020-0054BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 19315 CALLE DE BARCELONA Cupertino
APN: 375 04 005
PERMIT NO: BLD-2020-0054
CONTRACTOR:
SUCCESSFUL CONSTRUCTION INC, 42789 HAMILTON WAY FREMONT
CONTRACTOR PHONE:
510-676-3689
DATE ISSUED 8/3/2020 3:51:49 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $550000
JOB DESCRIPTION
GARAGE (479 SF); PORCHES (487 SF); SECOND STORY BALCONY (105 SF).
NEW 2 STORY SFD (2440 SF); ATTACHED
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
SUCCESSFUL
LICENSED
B GENERAL
LICENSED
913612
EXP
07/31/2022
I hereby
force
I hereby
CONSTRUCTION INC
CLASS:
BUILDING CONTRACTOR
NO:
DATE:
affirm that I am licensed
and effect.
affirm under penatiy
I have and will maintain a
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
certificate of consent to self -insure
Worker's Compensation Insurance, as
of the work for which this permit
If, after making this certificate of
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
provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
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
as
Sections
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 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
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
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
and state that the above
representatives of this city to enter
against liabilities, judgements, costs,
will comply with all non -point source
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.