B-2018-0547 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0547
10818 JUNIPER CT CUPERTINO,CA 95014-6556(342 57 008) WILLOW GLEN
ELECTRIC INC
SAN JOSE,CA 95155
OWNER'SNAME: DATE ISSUED:04/03/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lic.#591918
Contractor WILLOW GLEN ELECTRIC INC Date 04/30/2020 X BLDG—ELECT_PLUMB
I hereby affirm that 1 um licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)EV CHARGING STATION(240 V);NEW CIRCUIT(60 AMP)
I hereby affirm under penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided fmby Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
' have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for tire performance of the work for which this
/ permit is issued. Sq.Ft Floor Area: Valuation:$2000.00
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: Occupancy Type:
and stale laws relating to building construction,and hereby authorize 342 57 008
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 applica t u erstands and will comply with all non-point
source regulations pert a upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ( - Date 04-03-2018 Issued by:Kim Dunbar
Date:04/03/2018
O NER-BUILDEL2
I hereby aMrm that um exempt from the Contractor's License Law t'or one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If e roof is
r. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree m remove all new materials for
compensation,will do the work,and the structure is not intended ar offered for inspection.
sale(Sce.7044,Business&Professions Cade)
i. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec,7044,Business&Professions Code). Date:04-03-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 have and will maintain a Certificate of Consent to selMasmr for Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Wet ker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,far the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit Is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in Ore performance of the work for which this permit is issued,I material.&Safety Cade,Section 25532(x)should I store or handle hazardous
al.Heulth Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the contaminants as degned by the Bay rex Al Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cup9 tine unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a c, Mr ctlrn lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit las ed(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. 1 understand my plans shall be used as public records.
Licensed
Signature Date 04-03-2016 professional