BLD-2020-1270BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20200 LUCILLE AVE APT 58 CUPERTINO
APN: 316 02 094
PERMIT NO: BLD-2020-1270
CONTRACTOR: CORNERSTONE SELECT BUILDERS INC, 76 WRIGHT BROTHERS AVE FL 1 LIVERMORE
CONTRACTOR PHONE:
DATE ISSUED 8/24/2020 10:48:46 AM
ISSUED BY: KDUNBAR
VALUATION: $45000
JOB DESCRIPTION
(3) WINDOWS AND (1) SLIDER; (N) 100 AMP SUB -PANEL; KITCHEN REMODEL (88 SF); BATHROOM REMODEL (165 SF); REMODEL
AND A/C UNITS; SEE MASTER PLAN PERMIT B-2019-0090 FOR DRAWINGS
VERANDAS - UNIT 058- RE -PIPE ENTIRE UNIT (8); REPLACE
OTHER (122 SF); (N) LED LIGHTING (15 TOTAL); (N) FURNACE
LICENSED CONTRACTOR DECLARATION
DRYWALL
of Chapter 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
CORNERSTONE SELECT BUILDERS INC
CLASS: B GENERAL BUILDING CONTRACTOR, C-9
NO: 888881
DATE: 01 /31 /2021
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 three
to self -insure
Insurance,
for which this
this certificate
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
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
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
and the Health
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 9.12
le
with
equipment
Municipal
& 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
responsible for this project.
Firm Certification No:
this project.
An EPA Lead -Safe Certified Renovator will be
Firm Name:
No EPA Lead -Safe Certified Firm is required for
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
V
No
Lender's
Name:
APPLICATION CERTIFICATION
that the above
of this city to
costs,
non -point source
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 I
construction,
harmless the
the applicant
Signature:
.