BLD-2020-1111BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10067 JUDY AVE Cupertino
APN: 375 11 012
PERMIT NO: BLD-2020-1 1 1 1
CONTRACTOR:
GRADE A PLUMBING SERVICES INC, 19170 CALLE MONIZ MORGAN HILL
CONTRACTOR PHONE:
DATE ISSUED 8/7/2020 7:45:15 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $4050
JOB DESCRIPTION
INSTALL PROPERTY LINE CLEANOUT
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
GRADE
LICENSED
C36
LICENSED
962210
EXP
06/30/2021
I hereby
force
I hereby
A PLUMBING
CLASS:
PLUMBING
NO:
DATE:
affirm
and effect.
affirm
I have and
for which
I have and
I certify that
with
SERVICES INC
that I am licensed under the provisions of Chapter
under penatiy of perjury one of the following three declarations:
will maintain a certificate of consent to self -insure for
this permit is issued.
will maintain Worker's Compensation Insurance, as
in the performance of the work for which this permit
laws of California. If, after making this certificate of exemption,
such provisions or this permit shall be deemed revoked.
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
I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter
Health &
as defined
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
V
with
equipment
Municipal
Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
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
for this project.
Firm Certification No:
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
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
above information
to enter
costs,
source
is correct. I agree to comply with all city and county ordinances and state laws relating to building
upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
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 that the
and hereby authorize representatives of this city
City of Cupertino against liabilities, judgements,
understands and will comply with all non -point
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.