B-2018-1413 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1413
22013 BAXLEY CT CUPERTINO,CA 95014-4744(356 06 021) CALIFORNIA
WINDOW MASTERS
INSTALLATION
DUBLIN,CA 94568
OWNER'S NAME:FOUR SEASONS HOMES LLC DATE ISSUED:08/22/2018
OWNER'S PHONE: PRONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_17 L'Ic.#972680
Contractor CALIFORNIA WINDOW MASTERS INSTALLATION Data 05/31/2020 X BLDG_ELECT_PLUMB
I herebyfiirm that I.am licensed under the _MECH X RESIDENTIAL_COMMERCIAL
n provisions of 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:
REPLACE(9)WINDOWS LIKE FOR LIKE-TO MEET EGRESS
I hereby affirm under penalty of perjury one of the following two declarations:
t. 1 have and will maintain a certificate of consent to self-insure for WorkeNs
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance of the work for which this permit is issued.
•�� 1 have and will maintain Worker's Compensation Insumnce,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Flom Area: Valuation:$4600.00
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 state laws relating to building construction,and hereby authorize 356 06 021
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 applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 0 812 212 01 8 Issued by:Jasmine Archbold
Date:08/22/2018
OWNER-BiIII,DF.R UECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of fn, RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any rooting mandful being installed.His.of is
r. I,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
ompeasation,will do the work,and the structure is not intended or offered for inspcctien.
sale(Sec.7044,Business&Professions Cade)
z. L,as owner of the property,am exclusively contracting with licensed Signature ofApplica,,t:
contractors to construct the project(Sce.7044,Business&Professions Code), Date:08/22/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO ISE CLASS"A"OR BETTERt. I have and will maintain a Certificate of Cons it 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. I have and will maintain Worker's Compensation Insumnce,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Lubar Code,for the performance of the work nor 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
3. I certify that in the performance ofthe work for which this parent is issued,I Health&Safety Coda,Section 25532(.)should I store 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 hazardous
air contaminants as defined by the Bay Area Air Qo.lity Management District I
Worker's Compensation laws of California.If,ager making this cortifioala of will maintain compliance wlth the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2550,25533,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:0812212018
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,ON 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 MunicipalARCHITEC'P'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records,
Signature Data 08/22/2018 Licensed
Professional