B-2019-0549BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21700 RAINBOW CT CUPERTINO, CA 95014-
4829 CUPERTINO
APN: 366 38 002
PERMIT NO: B-2019-0549
:
DATE ISSUED 2/1/2021 2:10:27 PM
ISSUED BY: Sean Hatch
VALUATION: $10000
JOB DESCRIPTION
(155 SF) ; (N) EXTERIOR EGRESS STAIRS.
FIRST LEVEL ADDITION
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
B GENERAL
LICENSED
EXP
01/31/2022
I hereby
force
I hereby
ALLCONS
CLASS:
BUILDING
NO: 1007058
DATE:
affirm that
and effect.
affirm under
I have and will
for which this
I have and will
I certify that in
laws
with such
GROUP INC
CONTRACTOR
I am licensed under the provisions of Chapter
penatiy of perjury one of the following three
maintain a certificate of consent to self -insure
permit is issued.
maintain Worker's Compensation Insurance, as
the performance of the work for which this permit
of California. If, after making this certificate of
provisions or this permit 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
provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under Chapter
the Cupertino Municipal Code, Chapter 9.12 and the Health
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
EPA LEAD -SAFE DISCLOSURE
this project.
Firm Certification No:
An EPA Lead -Safe Certified Renovator will be responsible for
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
V
CONSTRUCTION LENDING AGENCY
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 construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have
construction, and
harmless the City of
the applicant understands
Signature:
\
read this application and state that the above
hereby authorize representatives of this city to enter
Cupertino against liabilities, judgements, costs,
and will comply with all non -point source
qf—
.