BLD-2020-1187BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21524 Conradia CT
APN: 356 23 054
PERMIT NO: BLD-2020-1 187
CONTRACTOR:
C M L CONSTRUCTION INC, 451 E. DUANE AVENUE SUNNYVALE
CONTRACTOR PHONE:
4087028877
DATE ISSUED 8/4/2020 5:25:44 PM
ISSUED BY: KDUNBAR
VALUATION: $0
JOB DESCRIPTION
(100 AMP)
(N) TEMPORARY POWER POLE -
LICENSED CONTRACTOR DECLARATION
provisions
of the
of consent
work
making
be
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
Joel
LICENSED
B GENERAL
LICENSED
780231
EXP
02/28/2022
I hereby
force
I hereby
Lujan
CLASS:
BUILDING CONTRACTOR
NO:
DATE:
affirm that I am licensed under the
and effect.
affirm under penatiy of perjury one
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the
laws of California. If, after
with such provisions or this permit shall
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.
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
9.12
under
and the
Code,
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
V
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
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
there 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and
representatives
against liabilities,
will comply
state
judgements,
with all
that the
of this city
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 have read this application
construction, and hereby authorize
harmless the City of Cupertino
the applicant understands and
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.