BLD-2021-1302BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10189 BYERLY CT Cupertino
APN: 342 12 083
PERMIT NO: BLD-2021-1302
OWNER'S NAME:
CONTRACTOR: IMAGINE UNIQUE CONSTRUCTION, 15166 LOS GATOS BLVD LOS GATOS
CONTRACTOR PHONE:
DATE ISSUED 8/6/2021 8:16:12 AM
ISSUED BY: KDUNBAR
VALUATION: $25000
JOB DESCRIPTION
(N) SWITCHES (5); (N) LIGHTS (16)
MASTER BATH REMODEL (150 SF); (N) OUTLETS (3);
LICENSED CONTRACTOR DECLARATION
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
12/31/2022
I hereby
force
I hereby
DATE:
and
I have
for
I have
I certify
with
IMAGINE UNIQUE CONSTRUCTION
CLASS:
BUILDING
NO: 1019318
affirm that I am licensed under the provisions
effect.
affirm under penatiy of perjury one of the
and will maintain a certificate of consent
which this permit is issued.
and will maintain Worker's Compensation
that in the performance of the work
laws of California. If, after making
such provisions or this permit shall be
following three declarations:
to self -insure for
Insurance, as provided
for which this permit
this certificate of exemption,
deemed revoked.
Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
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
under
and the Health
Chapter
& Safety
as defined
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
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 Code,
EPA LEAD -SAFE DISCLOSURE
responsible for this project.
Firm Certification No:
this project.
An EPA Lead -Safe Certified Renovator will be
Firm Name:
No EPA Lead -Safe Certified Firm is required for
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 the above information
of this city to enter
costs, and
all non -point source regulations
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
expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
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, judgements,
the applicant understands and will comply with
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.