BLD-2020-1851BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: MUST RETRIEVE DATA.
APN:
PERMIT NO: Error retrieving data or unable to retrieve all required fields.
Contact rosss@cupertino.org for assistance
:
DATE ISSUED MUST RETRIEVE DATA
ISSUED BY:
VALUATION:
JOB DESCRIPTION
MUST RETRIEVE DATA.
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
CI 0C
LICENSED
EXP
6/30/22
I hereby
force
I hereby
MUST RETRIEVE DATA.
CLASS:
46
NO: MUST RETRIEVE DATA.
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 to
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,
I certify that in the performance of the work for which
laws of California. If, after making this certificate
with such provisions or this permit shall be deemed
three declarations:
self -insure for Worker's Compensation, as provided
as provided for by Section 3700 of the
this permit is issued, I shall not employ any person
of exemption, I become subject to the
revoked.
for by Section 3700 of the Labor Code, for the performance of the
V
work
Labor Code, for the performance of the work for which this permit is
in any manner so as to become subject to the Worker's
Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
the
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 and
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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
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
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CONSTRUCTION LENDING AGENCY
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 is a
No
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Lender's
Name:
APPLICATION CERTIFICATION
application and state that the
representatives of this
against liabilities, judgements,
will comply with all non -point
0
above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
city 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
and hereby authorize
City of Cupertino
understands and
SA
.