BLD-2020-1355 Permit8/26/2020
CITY OF CUPERTINO BUILDING PERMIT
BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10382 LAS ONDAS WAY Cupertino
APN: 369 28 036
PERMIT NO: BLD-2020-1355
OWNER'S NAME: MIZERAK ROBERT
OWNER'S PHONE: Not Provided
:
DATE ISSUED 8/26/2020 2:12:08 PM
ISSUED BY: haleym
VALUATION: $8000
JOB DESCRIPTION
KITCHEN REMODEL LIKE FOR LIKE (90 SF)
LICENSED CONTRACTOR DECLARATION
NO: 1057819 EXP DATE: 09/30/2021
7000) of Division 3 of the Business & Professions Code and that my license is in full force
CONTRACTOR:
I hereby
and
I hereby
affirm
effect.
affirm
I have and
this permit
have and
I certify
permit shall
PALM CONSTRUCTION INC LICENSED CLASS: B GENERAL BUILDING LICENSED
CONTRACTOR
that I am licensed under the provisions of Chapter 9 (commencing with Section
under penatly of perjury one of the following three declarations:
will maintain a certificate of consent to self -insure for Worker's Compensation, as
is issued.
will maintain Worker's Compensation Insurance, as provided for by Section 3700
that in the performance of the work for which this permit is issued, I shall not employ
If, after making this certificate of exemption, I become subject to the Worker's Compensation
be deemed revoked.
provided for by Section 3700 of the Labor Code, for the performance of the work for
which
of the Labor Code, for the performance of the work for which this permit is issued.
any person in any manner so as to become subject to the Worker's Compensation laws
provisions of the Labor Code, I must forthwith comply with such provisions or
VII
of California.
this
HAZARDOUS MATERIALS DISCLOSURE
& Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the
I have read
Municipal
the hazardous materials requirements under Chapter 6.95 of the California Health
FA
Cupertino
Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should
I store or handle hazardous material. Additionally, should I use equipment or devices
I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District
the Health & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
.-
I
Firm Certification No:
i
An EPA Lead -Safe Certified Renovator will be responsible for this project.
r
I 1
Firm Name:1 '
EPA Lead -Safe Certified Firm is required for this project.
Certified
ViNo
CONSTRUCTION LENDING AGENCY
of the work which this permit is issued (Section 3097, Civil Code).
r
Lender's Address: '
;
I hereby
IYeslNo
affirm
under penalty of perjury that there is a construction lending agency for the performance
e- ►
' ;
VI
Lender's
Name:
APPLICATION CERTIFICATION
to comply with all city and county ordinances
property for inspection purposes.
said City in consequence of the
Code, Section 9.18.
and state laws relating to building
(We) agree to save indemnify and keep harmless
granting of this permit. Additionally, the applicant
I certify that I
construction,
the City of Cupertino
understands
Signature:
have read this application and state that the above information is correct. I agree
and hereby authorize representatives of this city to enter upon the above mentioned
against liabilities, judgements, costs, and expenses which may accrue against
and will comply with all non -point source regulations per the Cupertino Municipal
\16.88888.888 /
.
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 365
https://apps.cupertino.org/Accela/BLD-Sign-Permit.aspx?AccelaUser=ONETIMESIGN&OTK=mkyJCNTa2C6gZgUsKHWAjgbBJcyJVNDNu3y89v1Ospt... 1/1