BLD-2021-0385BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20488 STEVENS CREEK BLVD UNIT 1413
CUPERTINO
APN:
369 53 120
PERMIT NO: BLD-2021-0385
:
DATE ISSUED 3/2/2021 3:19:08 PM
ISSUED BY: KDUNBAR
VALUATION: $30000
JOB DESCRIPTION
(150 SF) & INSLULATION; FLOORING & FLOOR MUFFLER UNDERLAYMENT (350 SF)
UNIT 1413- WATER DAMAGE - REPLACE DRYWALL
LICENSED CONTRACTOR DECLARATION
C33 PAINTING
following
for
this
be deemed
AND DECORATING
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
05/31/2022
I hereby
force
I hereby
AXIS SERVICES INC
CLASS:
BUILDING CONTRACTOR, C10 ELECTRICAL,
NO: 617681
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall
three declarations:
to self -insure for
Insurance, as
which this permit
certificate of exemption,
revoked.
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
I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
and
under Chapter
the Health &
as defined
Code, Sections
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
V
with
equipment
Municipal
Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
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
Code, Chapter 9.12 and the Health & Safety
EPA LEAD -SAFE DISCLOSURE
be responsible for this project.
Firm Certification No:
for this project.
An EPA Lead -Safe Certified Renovator will
Firm Name:
No EPA Lead -Safe Certified Firm is required
Certified
V
CONSTRUCTION LENDING AGENCY
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 there
No
V
Lender's
Name:
APPLICATION CERTIFICATION
that
judgements,
all
of
non
the above information
this city to enter
costs,
-point source
I(
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 read this application and state
construction, and hereby authorize representatives
harmless the City of Cupertino against liabilities,
the applicant understands and will comply with
Signature:
su5l
.