BLD-2020-1334BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10192 PARLETT PL Cupertino
APN: 316 26 058
PERMIT NO: BLD-2020-1334
CONTRACTOR: HARRIS WATER HEATERS INC, 21508 GAIL DRIVE CASTRO VALLEY
CONTRACTOR PHONE:
DATE ISSUED 8/27/2020 1 1:50:54 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $903
JOB DESCRIPTION
HEATER LIKE FOR LIKE - IN GARAGE
(N) 50-GALLON WATER
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
HARRIS
CLASS: C36 PLUMBING
NO: 1026214
DATE: 1 1 /30/2020
affirm that I
and effect.
affirm under
I have and will
for which this permit
I have and will
I certify that in the
laws
with such provisions
WATER HEATERS INC
am licensed under the provisions of Chapter
penatiy of perjury one of the following
maintain a certificate of consent to self
is issued.
maintain Worker's Compensation Insurance,
performance of the work for which
of California. If, after making this certificate
or this permit shall be deemed
three declarations:
-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
V
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.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
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 under
the Cupertino Municipal Code, Chapter 9.12 and the
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 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 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
construction, and hereby
harmless the City of
the applicant understands
Signature:
this application and state that the
authorize representatives of this city
Cupertino against liabilities, judgements,
and will comply with all non -point
.