D-2018-0032 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0032
21020 HOMESTEAD RD CUPERTINO,CA 95014-0240(326 07 020) R C P CONSTRUCTION
INC
EL DORADO HILLS,
CA 95762
OWNER'S NAME;HEDONGLLC DATE ISSUED:05/14/2018
OWNER'S PHONE: PRONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 5 Lie.#661482
Contractor R C P CONSTRUCTION INC Date 09130/2019 —BLDG ELECT—PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
DEMO(5265 SF)-EXISTING SITE DEMO INCLUDING BUILDING,
I hereby affirm under penalty of perjury one ofthe following the declarations: SURFACE IMPROVEMENTS,UNDERGROUND WETAND DRY
r. I have and will maintain a certificate of consent to self-insure Por Worker's UTILITIES,PREPARE(N)PAD FOR PROPOSED BANK BUILDING
Compensation,as provided for by Section 3700 of the Labor Code,For the AND LOT IMPROVEMNTS
performance ofthe work for which this permit is issued.
z. 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 Arco: Valuation:$0.00
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: Oce taincy Type:
and state laws relating to building construction,and hereby authorize 326 07 020
representatives of this city to enter upon the above mentioned property far
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 this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all ll non-point
source regulations per the Cupertino Municipal Code,Section 9.16, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 05/14/2018 Issued by:Jasmine Archbold
Date:05/14/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Lmv,for ane of the RE-ROOFS,
following two reasons: All roofs shall be inspected prior to any mating material being installed,If..of is
t. 1,as owner ofthe property,army employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and die shmcmre is not intended or offered for inspection.
sale(Scc.7044,Business&Professions Code)
z. I,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/14/2018
1 hereby affirm under penalty of perjury one of tire following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"012 BETTER
r. I have and will maintain a Certificate of Consentto self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe 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 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9,12 and tine
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ n an manner so as to become subjmaterial.Additionally,should I use equipment or devices which enrft hazardous
I y a y person i n y Ject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,aher taking this certificate of will maintain complhmce with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions ofthe tine Health&Safety Code,Sections 25505,25533,and 25534•
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/14/2018
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 ARCHITEC'P'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 05/14/2018 Licensed
Professional