BLD-2020-1029BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10349 CRESTON DR Cupertino
APN: 326 37 010
PERMIT NO: BLD-2020-1029
OWNER'S NAME:
CONTRACTOR: BLACK DIAMOND PAVER STONES & LANDSCAPE INC, 1975 HAMILTON AVE STE 5 SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 2/3/2021 10:05:34 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $16500
JOB DESCRIPTION
(256 SF) WITH ELECTRICAL; OUTDOOR KITCHEN WITH ELECTRICAL.
CONSTRUCT (N) PATIO COVER
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
C27
LICENSED
EXP
01/31/2022
I hereby
force
I hereby
BLACK DIAMOND
CLASS:
LANDSCAPING
NO: 841042
DATE:
affirm that I am licensed
and effect.
affirm under penatiy
I have and will maintain
for which this permit is
I have and will maintain
I certify that in the performance
laws of California.
with such provisions
PAVER STONES & LANDSCAPE INC
under the provisions of Chapter
of perjury one of the following
a certificate of consent to self -insure
issued.
Worker's Compensation Insurance,
of the work for which this
If, after making this certificate
or this permit shall be deemed revoked.
three 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
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 under
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
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
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
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 that I have
construction, and
harmless the City
the applicant understands
Signature:
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.