BLD-2020-2030BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20200 LUCILLE AVE APT 55 CUPERTINO
APN: 316 02 094
PERMIT NO: BLD-2020-2030
OWNER'S NAME: VERANDAS APARTMENTS LLC
OWNER'S PHONE: 408-257-9941
JOB DESCRIPTION
(3) WINDOWS AND (1) SLIDER; (N) 100 AMP SUB -PANEL; RE -PIPE ENTIRE UNIT; REPLACE (3) WINDOWS AND (1) SLIDER; (N) 100
BATHROOM REMODEL (165 SF); REMODEL OTHER (122 SF); (N) LED LIGHTING (15 TOTAL); (N) FURNACE AND A/C UNITS; SEE MASTER
VERANDAS - UNIT 55 - RE -PIPE ENTIRE UNIT; REPLACE
AMP SUB -PANEL; KITCHEN REMODEL (88 SF);
PLAN PERMIT B-2019-0090 FOR DRAWINGS
LICENSED CONTRACTOR DECLARATION
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B GENERAL
LICENSED
EXP
01/31/2021
I hereby
force
I hereby
CORNERSTONE SELECT BUILDERS INC
CLASS:
BUILDING CONTRACTOR, C-9 DRYWALL
NO: 888881
DATE:
affirm that I am licensed under the
and effect.
affirm under penatiy of perjury one
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the
laws of California. If, after making
with such provisions or this permit shall
of the following three
of consent to self -insure
Insurance,
work for which this
this certificate
be deemed 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
under
9.12 and the Health
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
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 Code,
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm is required
Certified
V
CONSTRUCTION LENDING AGENCY
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 that
No
V
Lender's
Name:
APPLICATION CERTIFICATION
state that the above
of this city
judgements,
with all non -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
construction,
harmless
the
Signature:
that
applicant
I
the
Sgrr
have read this application and
and hereby authorize representatives
City of Cupertino against liabilities,
understands and will comply
jeik riN,
.