B-2018-1390 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1390
1173 STAFFORD DR CUPERTINO,CA 95014-4968(362 06 027) ROOTER HERO
PLUMBING INC
MISSION HILLS,CA
91346
OWNER'S NAME: DATE ISSUED:08/17/2018
OWNER'S PHONE: PHONE NO:(
LICENCED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.#973014
Contractor ROOTER HERO PLUMBING INC Date 05/31/2020 X BLDG—ELECT X PLUMB
MI CH 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:
SEWER LINE REPAIR/INSTALL BUILDING CLEAN OUT
I hereby affirm under penalty of perjury one of the following two declarations:
I. 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
performance of the work far which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided far by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued, - Sq.Ft Floor Arca: Valuation:$4000.00
APPLICANT CER'fIFICA"CION
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 slate laws relating to building construction,and hereby authorize 362 06 027
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 WORT{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 pe ae Cuper Ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature
Data tl'//2—y If' Issue([by:Jasmine Archbold
Date:08/17/2018
OWNER-BUILDERDFCIARATION -
I hereby affirm that I am exempt front the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed,Its root'is
r. 1,as owner of the property,or my 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 the structure is not intended or offered for inspection
sate(Sec.7044,Business&Professions Code)
x. 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:
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
�. 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
a 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous mate•lals requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance ofthe work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain aintacompliance with with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issued,I health&Safety Code,Section 25532(.)should I store or handle hazm•dmas
shall not employ person in an annar so as[o become subject to the material.Additionally,should I use equipment or devices which emit hazardous
p y any pe y n' J 'air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,ager making this certificate of will maintain compliance with the CuperHno nicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 05,25533, nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERT ION Date:
I oeflify 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(his 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 Professional