B-2018-0922 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0922
23300 VIA ESPLENDOR UNIT 52 CUPERTINO,CA 95014-6548(342 55 037) DAY AREA
ENTERPRISE
SAN JOSE,CA 95148
OWNER'S NAME: DATE ISSUED:05/30/2018
OWNER'S PHONE: PHONE NO:(408)238-5043
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lip.#817817
Contractor BAYAREA ENTERPRISE Date 03/31/2019 X BLDG X ELECT X PLUMB
I hereby affirm that I nm licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 ot'the Business&Professions Code and that my
license is in till force and effect. JOB DESCRIPTION:
THE FORUM VILLA 5-l)CHANGE(9)RECESSED LED LIGHTS;2)
1 hereby affirm under penalty of perjury one of the following two declarations: REPLACE(25)OUTLETS;3)REPLACE(14)SWITCHES;4)
t. I have and will maintain a certificate of em sent to sel£-insure for Worker's UPGRADE(1)SHOWER PAN AND VALVES;5)REPLACE(2)BATH
Compensation,as provided for by Section 3700 of the Labor Code,For the FANS;6)UPGRADE(I)BATH SURROUND AND SHOWER VALVE;7)
performance of the work for which this permit is issued. RUN 3/4"GAS LINE TO FIRE PLACE.
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:$18000.00
APPLICANT 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 APN Number: Occupnucy Type:
and state laws relating to building construction,and hereby authorize 342 55 037
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,costs,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_gppi dersmmJs and will comply with all non-point
source toupon r he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/30/2018 Issued by:Jl,smine Archbold
Date:05/30/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one at'theRE-ROOFS•
1'ollovfng tyro reasons: All roofs shall be inspected prior to any roofing material being installed.It's.of is
r. I,as owner of the property,or my employees with wages as their sole irstrllpd without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 1,re owner of the property,am exclusively contracting with licensed Signature ofApplicanc
connectors to construct the project(Sec,7044,Easiness&Professions Code). Date:05/30/2018
I hereby affirm under penalty of perjury one or the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 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. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 or the
Section 3700 of the Labor Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. m aintain compliance with the Cupertino Manlcipal Cade,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Section 25532(a)should I stare or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardnas
air cents minuo s as refrned by the Bay Area Air Quality Management District 1
Worker's Compensation Taws of California. If,after making this certificate of will maintain compliance with the Cupertin uta pat Code,Chaptw 9.12 and
exemption,I became subject to the Worker's Compensation In of the the Health&Safety C derSycti r .505;L 125534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: _
APPLICANT CERTIFICATION Data:05130/2018
I certify that I have read this application and state that the above information is CONSTRD Tfo LE DI FN
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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 05/30/2018 Licensed
Professional