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BLD-2020-0434BUILDING PERMIT CUPERTINO CITY HALL 10300 Torre Avenue • Cupertino, CA 95014-3255 PHONE 408-777-3228 WWW.CUPERTINO.ORG BUILDING ADDRESS: 859 BETTE AVE Cupertino APN: 369 27 044 PERMIT NO: BLD-2020-0434 OWNER'S NAME: OWNER'S PHONE: Not Provided CONTRACTOR: BUILD BY TITAN INC, 325 PHELAN AVE SAN JOSE CONTRACTOR PHONE: DATE ISSUED 9/22/2020 8:55:30 AM ISSUED BY: JASMINE ARCHBOLD VALUATION: $15000 JOB DESCRIPTION -LESS WATER HEATER AND (N) MINI SPLIT SYSTEM. CONVERT (E) 2-CAR GARAGE TO ADU (427 SF) WITH (N) TANK 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 06/30/2022 I hereby force I hereby CLASS: BUILDING NO: 948867 DATE: affirm and effect. affirm I have and for which I have and I certify that with BUILD BY TITAN INC CONTRACTOR, C54 TILE (CERAMIC AND MOSAIC) that I am licensed under the provisions of Chapter under penatiy of perjury one of the following will maintain a certificate of consent to self this permit is issued. will maintain Worker's Compensation Insurance, in the performance of the work for which laws of California. If, after making this certificate such provisions or this permit shall be deemed three declarations: -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Co lie, 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 this 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 revoked. 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 V with equipment Municipal Health & 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 for this project. Firm Certification No: An EPA Lead -Safe Certified Renovator will be responsible 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 above 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 construction, harmless the applicant Signature: I have read this application and state that the and hereby authorize representatives of this city the City of Cupertino against liabilities, judgements, understands and will comply with all non -point 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.