BLD-2019-1302 PermitBUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 6199 SHADYGROVE DR CUPERTINO
APN: 375 40 018
PERMIT NO: BLD-2019-1302
CONTRACTOR: H Q Y CONSTRUCTION CORPORATION, 3815 COLEGROVE ST SAN MATEO
CONTRACTOR PHONE:
DATE ISSUED 8/22/2020 9:22:56 PM
ISSUED BY: PhuongD
VALUATION: $15000
JOB DESCRIPTION
KITCHEN REMODEL (200 SF); REMODEL OTHER (160 SF); UPGRADE MAIN ELEC. PANEL (200 AMPS)
ADDITION (400 SF);
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
LICENSED
EXP
I hereby
force
I hereby
H Q Y
CLASS: B GENERAL
NO: 969600
DATE: 10/31/2020
affirm that
and effect.
affirm under
I have and will
for which this
I have and will
I certify that in
laws
with such
CONSTRUCTION CORPORATION
BUILDING CONTRACTOR
I am licensed under the provisions of Chapter
penatiy of perjury one of the following three
maintain a certificate of consent to self -insure
permit is issued.
maintain Worker's Compensation Insurance,
the performance of the work for which this permit
of California. If, after making this certificate
provisions or 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
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
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 Chapter
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 as
Code, Chapter 9.12 and the Health & Safety Code, Sections
EPA LEAD -SAFE DISCLOSURE
this project.
Firm Certification No:
An EPA Lead -Safe Certified Renovator will be responsible for
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
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter 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
construction,
harmless
the applicant
Signature:
I have
and
the City
understands
read this application and state that the above
hereby authorize representatives of this city to
of Cupertino against liabilities, judgements, costs,
and will comply with all non -point source
.