D-2018-0036 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0036
1598 POPPY WAY CUPERTINO,CA 95014-5307(366 20 t06) DIG&DEMO INC
SAN RAMON,CA
94583
OWNER'S NAME: DATE ISSUED:06/04/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 8 Lic.#9939
Contractor DIG&DEMO INC Date 96/30/2018 —BLDG ELECT_PLUMB
1 hereby affirm that I am licensed trader the provisions atChapter 9(commencing —MECH X RESIDENTIA —COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
POOL DEMO FOR LANDSCAPE PURPOSE ONLY(476 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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
rr 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. Sq.Ft Floor Area: Valuation:$13000.00
APPLICANT T21FICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 366 10 106
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,judgments,casts,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per theCupe t o Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/04/2018 Issued by:Kim Dunbar
Date:06/04/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of flicRE-ROOFS•
following twu on
reass: All roofs shall be inspected prior to any roofing material being installed.it..or is
r. 1,as owner of the property,or my employees with wages as her sole nstalled without first obtaining on inspection,I agree to remove ell new materials for
compensation,will do the work,and the structure is not intended or offered far inspection.
sale(Sec.7044,Business&Professions Cade)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code), Date:06/04/2018
1 hereby affirm under penalty of perjury one M the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 have and will maintain a Cei tifcate 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, HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 695 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. I certify that in theof the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any
person
in n any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,afar making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l became subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 5505, and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:06/04/2018
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
Judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal AltCkll'1'EC'1"S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
ed
Signature Date 06/04/2018 Professional
ofesssi
Profeonal