BLD-2020-1247 ssued.
1 cerify that in the performance of the wcrk fcr which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS.MATENALS DISCLOSURE
d
BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue - Cupertino, CA 95014-3255
PHONE 408-777-3228
BUILDING ADDRESS: 22555 CRISTO REY DR Cupertino i APN: 342 63 005
OWNER'S NAME: ROMAN CATHOLIC BISHOP OF SAN JOSE
CONTRACTOR: HOUGH CONSTRUCTION CO INC. 303 LINDA DRIVE HOLLISTER CONTRACTOR PHONE:
PERMIT NO: BLD-2020-1247
OWNER'S PHONE Not Provided
JOB DESCRIPTION
GATE OF HEAVEN CATHOLIC CEMETERY - NEW PERGOLA (302sf)
1
J.IgEBSF,p CONTRACTOR QECL.ARATiOt4
CONTRACTOR: HOUGH CONSTRUCTION CO INC
LICENSED CLASS:
B GENERAL BUILDING CONTRACTOR, C35 LATHING AND PLASTERING
LICENSED NO: 498686
EXP DATE:
09/30/2022
I hereby affirm that I am licensed under the provisions of Ch:-ra+er 9 (commencir:a with Section 7003) of Division_3 of the 6tisine,ss °. Professions Cor.fr, and that my license is in full
force and effect.
I hereby affirm under penalty of perjury one of the following three declarations:
I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by ection 37c0 of the Leber ;:;efor the performance of the
work for which this permit is issued.
VP
i have and will maintain Worker's Compensation insurance, as provided for by Section 3700 of the Labor Code, for fhe performance of the work fcr which this permit is
i have read the hazardous materials requirements under Chapter 6.95 of the Coliforri_: itaoith R. Sc-fe v Cc :tr.!.. ectc.:ins 2 _'S, 25533. and 2.5534. 1 will maintain compliance
i with the Quoertin. C.:hooter and the Health & Safety Code, Section 25532(o) should I store or handle hazardous material. Additionally, should I use
equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
gPA LEAP-SAFF,D!SCLOSURE,
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name:
.� No EPA Lead -Safe Certified Firm is required fcr this project.
Firm Certification No:
CONSTRUCTIO jj NDINAGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency fcr the performance cf The wcrk which this permit is issued (Section 3097, Civil Code).
Yes V No
Lender's Name:
Lender's Address: I
APPLICATION CERT1FIQ4TIOt4
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building I
construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgements, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Addition° ly,
the applicant understands and will comply with all non -point source regulations per the
Signature:
Every permit Issued shall become invalid unless the work on the site authorized by such permit Is commenced within 345 days after its Issuance. or It the work authorized on the site by such permit is suspended or abandoned for a period
1 of 365 dap after tho time the work is commenced.