BLD-2020-1618B8ILDING PERMI7
CITY HALL
10300 Torre AYenXe CXperWino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
B8ILDING ADDRESS: 22801 STONEBRIDGE ST CXperWino APN: 342 13 044 PERMI7 NO: BLD-2020-1618
O:NER'S NAME: O:NER'S PHONE: NoW ProYided
CON7RAC7OR: QUARTZ CONSTRUCTION, 1777 HAMILTON AVENUE STE 1080 SAN JOSE CON7RAC7OR PHONE:
DA7E ISS8ED 10/15/2020 7:12:10 AM ISS8ED B<: PhXongD 9AL8A7ION: $18200
JOB DESCRIP7ION
BATHROOM REMODEL (140 SF) LIKE FOR LIKE
LICENSED CON7RAC7OR DECLARA7ION
CON7RAC7OR: QUARTZ CONSTRUCTION
LICENSED CLASS:
B GENERAL BUILDING CONTRACTOR
LICENSED NO: 1003436
E;P DA7E:
05/31/2021
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I haYe and Zill mainWain a cerWificaWe of conVenW Wo Velf-inVXre for Worker'V CompenVaWion, aV proYided for b\ SecWion 3700 of Whe Labor Code, for Whe performance of Whe
Zork for Zhich WhiV permiW iV iVVXed.
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HA=ARDO8S MA7ERIALS DISCLOS8RE
I haYe read Whe ha]ardoXV maWerialV reqXiremenWV Xnder ChapWer 6.95 of Whe California HealWh & SafeW\ Code, SecWionV 25505, 25533, and 25534. I Zill mainWain compliance
ZiWh Whe CXperWino MXnicipal Code, ChapWer 9.12 and Whe HealWh & SafeW\ Code, SecWion 25532(a) VhoXld I VWore or handle ha]ardoXV maWerial. AddiWionall\, VhoXld I XVe
eqXipmenW or deYiceV Zhich emiW ha]ardoXV air conWaminanWV aV defined b\ Whe Ba\ Area Air QXaliW\ ManagemenW DiVWricW I Zill mainWain compliance ZiWh Whe CXperWino
MXnicipal Code, ChapWer 9.12 and Whe HealWh & SafeW\ Code, SecWionV 25505, 25533, and 25534.
EPA LEAD-SAFE DISCLOS8RE
An EPA Lead-Safe CerWified RenoYaWor Zill be reVponVible for WhiV projecW.
CerWified Firm Name:
No EPA Lead-Safe CerWified Firm iV reqXired for WhiV projecW.
CONS7R8C7ION LENDING AGENC<
I hereb\ affirm Xnder penalW\ of perjXr\ WhaW Where iV a conVWrXcWion lending agenc\ for Whe performance of Whe Zork Zhich WhiV permiW iV iVVXed (SecWion 3097, CiYil Code).
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Lender'V Name:
APPLICA7ION CER7IFICA7ION
I cerWif\ WhaW I haYe read WhiV applicaWion and VWaWe WhaW Whe aboYe informaWion iV correcW. I agree Wo compl\ ZiWh all ciW\ and coXnW\ ordinanceV and VWaWe laZV relaWing Wo bXilding
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Whe applicanW XnderVWandV and Zill compl\ ZiWh all non-poinW VoXrce regXlaWionV per Whe CXperWino MXnicipal Code, SecWion 9.18.
SignaWXre:
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Firm CerWificaWion No:
Lender'V AddreVV: