BLD-2021-0166BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 5926 SUTTON PARK PL Cupertino
APN: 375 35 032
PERMIT NO: BLD-2021-0166
OWNER'S NAME: CROFT STEPHEN C AND COYNE TRIONA
OWNER'S PHONE: Not Provided
JOB DESCRIPTION
FOR LANDSCAPE PURPOSE ONLY
DEMO POOL (420 SF)
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
A GENERAL
LICENSED
EXP
11/30/2021
I hereby
force
I hereby
L P CONSTRUCTION
CLASS:
ENGINEERING CONTRACTOR,
NO: 681249
DATE:
affirm that I am licensed under
and effect.
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California. If, after
with such provisions or this permit
C-8 CONCRETE
the provisions of Chapter
one of the following three
of consent to self -insure
Compensation Insurance,
of the work for which this
making this certificate
shall 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
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
Chapter 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
the Cupertino Municipal Code,
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
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
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
representatives
will comply
and state that the above
of this city
liabilities, judgements,
with all non -point
✓
1 wi-r
1.
.