BLD-2019-0965_SignedPermitCITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS:20800 HOMESTEAD, 62D CUPERTINO, CA APN:
PERMIT NO: BLD-2019-0965
OWNER'S NAME: MARKHAM APARTMENTS LP
OWNER'S PHONE:
CONTRACTOR: AMERICAN WATER HEATER SERVICE INC
CONTRACTOR PHONE:
DATE ISSUED: 09/18/2019 ISSUED BY: JARCHBOLD VALUATION: $1653.00
JOB DESCRIPTION:
BLDG 62 UNIT 62D - N 50 GALLON WATER HEATER SAME LOCATION IN DECK/PATIO
LICENSED CONTRACTOR'S DECLARATION:
CONTRACTOR: LICENSED CLASS: LICENSED NO: EXP DATE:
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
13 I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
fl I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to
become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to
the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code,
Sections 25505, 25533, and 25534.
j� An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification No:
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued
(Section 3097, Civil Co�7
Yes tI V
Lender's Name:
Lender's Address:
APPLICATION CERTIFICATION
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state
laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection
purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgements, costs, and expenses which may
accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point
source regula ' per th tino unicilDal Cod ction 9.18.
9
Signatu Date G�
EVERY PERM UED SHALL �INVAUNLS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 365 DAYS AFTER ITS ISSUANCE,
OR IF THE WORK AUTHORIZED ONERMIT IS SUSPENDED OR ABANDONED FOR A PERIOD OF 365 DAYS AFTER THE TIME THE WORK IS COMMENCED.