BLD-2020-1436BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21760 MEYERHOLTZ CT Cupertino
APN: 326 48 038
PERMIT NO: BLD-2020-1436
CONTRACTOR: MIKE COUNSIL PLUMBING INC, 1915 O'TOOLE WAY SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 9/18/2020 3:32:43 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $51404
JOB DESCRIPTION
FEET) - (2 CONNECTIONS); REPLACE UNDERFLOOR DRAIN/WASTE LINES (8 FIXTURES); INSTALL HOUSE AND PROPERTY LINE CLEANOUTS:
REPLACE UNDER HOUSE SEWER LINE (10
TRENCHLESS SANITARY SEWER LINE REPLACEMENT
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C36
LICENSED
EXP
04/30/2021
I hereby
force
I hereby
MIKE COUNSIL PLUMBING INC
CLASS:
PLUMBING
NO: 679261
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the following
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 for which
laws of California. If, after making this
with such provisions or this permit shall be deemed
three
to self -insure
Insurance,
this
certificate
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
requirements
9.12 and
under
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
the Cupertino Municipal Code, Chapter
V
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
will be responsible for this project.
Firm Certification No:
required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm is
Certified
v
CONSTRUCTION LENDING AGENCY
that there 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that
of
liabilities, judgements,
with all non
the above
this city
-point
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
construction,
harmless the
the applicant
Signature:
have read this application
and hereby authorize representatives
City of Cupertino against
understands and will comply
.