B-2018-1132CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-1132
19917 TWILIGHT CT CUPERTINO, CA 95014-2304 (316 31 032)
SPRINGER
CONSTRUCTION
AROMAS, CA 95004
OWNER'S NAME: Scott Gregory M Trustee
DATE ISSUED: 07/12/2018
OWNER'S PHONE:
PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #770676
Contractor SPRINGER CONSTRUCTION Date 10/31/2019
3X BLDG X ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
SECOND FLOOR - CONVERT AREA TO (N) BATHROOM (50 SF) AND
I hereby affirm under penalty of perjury one of the following two declarations:
INSTALL 1) NEW WINDOW, BATHROOM REMODEL MASTER (150
t. I have and will maintain a certificate of consent to self -insure for Worker's
SF); FIRST FLOOR - REMOVE BRICK FIREPLACE, INSTALL (N)
Compensation, as provided for by Section 3700 of the Labor Code, for the
SLIDING DOOR; PANEL UPGRADE (200 AMP).
performance of the work for which this permit is issued.
REV#1 - MOVE MASTER BATH TUB LOCATION (BACK TO
I ve and will maintain Worker's Compensation Insurance, as provided for b
ORIGINAL LOCATION) - BUILD DECK OUTSIDE FRENCH DOORS -
ec ' n 3700 of the Labor Code, for the performance of the work for which 4
SUED 8/28/18
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Sq. Ft Floor Area:
Valuation: $25000.00
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
APN Number:
Occupancy Type:
inspection purposes. (We) agree to save indemnify and keep harmless the
316 31 032
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against aid City in consequence of the granting of this permit.
Additionally, the ap icant understands and will comply with all non -point
PERMIT EXPIRES IF WORK IS NOT STARTED
source regula' n erthe up i Municipal Code, Section 9.18.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature a 08/28/18
R DECLARATION
Issued by: Kim Dunbar
Date: 07/12/2018
I hereby affix at I am exempt from the Contractor's License Law for one of the
following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
RE -ROOFS.
compensation, will do thework, and the structure is not intended or offered for
All roofs shall be inspected prior to any roofing material being installed. If a roof is
sale (Sec.7044, Business & Professions Code)
installed without fust obtaining an inspection, I agree to remove all new materials for
2. I, as ownerof the property, am exclusively contracting with licensed
inspection.
contractors to construct the project (Sec.7044, Business & Professions Code).
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations:
Date: 08/28/18
1. 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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
performance of the work for which this permit is issued.
2. 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
HAZARDOUS MATERIALS DISCLOSURE
permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
s. I certify that in the performance of the work for which this permit is issuedI
,
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Worker's Compensation laws of California. If, after making this certificate of
material. Additionally, should I use eq 77�went or devices which emit hazardous
exemption, I become subject to the Worker's Compensation provisions of the
air contaminants as defined by the Ba rea Air Quality Management District I
Labor Code, I must forthwith comply with such provisions or this permit shall
will maintain compliance with the Cu ino Municipal Code, Chapter 9.12 and
be deemed revoked.
the Health & Safety Code, do 50 , 25533, and 25534.
APPLICANT CERTIFICATIONa
I certify that I have read this application and state that the above information is
Owner or authorized agent:
correct. I agree to comply with all city and county ordinances and state laws
Date: 08/28/18
relating to building construction, and hereby authorize representatives of this city
CONS C G CV
to enter upon the above mentioned property for inspection purposes. (We) agree
I hereby affirm that there is a const ction lending a ncy for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities,
of work's for which this permit is is ed (Sec. 3097,
judgments, costs, and expenses which may accrue against said City in
Lender's Name
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Lender's Address
Code, Section 9.18.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 08/28/18
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1132
19917TWI LIGHT CT CUPERTINO,CA 95014-2304(31631032) SPRINGER
CONSTRUCTION
AROMAS,CA 95004
OWNER'SNAME:Scott Gregory M Trustee DATE ISSUED:07/12/2018
OWNER'S PHONE:408-420-4451 PRONE No:(831)596-6023
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#770676
Contractor SPRINGER CONSTRUCTION Date 10/31/2019 X BLDG X ELECT_PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
p p (commencing
with Section 7000)of Division 3