B-2018-1384 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT'NO:B-2018-1384
10099 RIDOE WAY DR CUPERTINO,CA 95014-2658(342 41 022) ELEMENT HOME
SOLUTIONS INC
OAKLAND,CA 94611
OWNER'S NAME: DATE ISSUED:08/15/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#997392
Contractor ELEMENT HOME SOLUTIONS INC Date 10/31/2018 X BLDG ELECT_PLUMB
I hereby m'Brm that 1 on licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)ofDivislon 3 of the Business&Professions Code and that try
license Is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION)-REPLACE AC UNIT
I hereby affirm under penalty of perjury one of the following two declarations: (SAME LOCATION)
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
performance of the work for which this permit is issued.
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 Area: Vuh iter:$18500.00
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 342 41 022
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 Issued by:Kim Dunbar
Date:08/15/2018
OWNER-
I hereby affirm that I am exempt from the Contractor's License Law far one of the RL-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed,If's roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2 1,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Scc,7044,Business&Professions Code). Date:8-15-2018
I hereby nMrm under penalty I'perjury one of the following three declarations: pI,I.ROOF COVERINGS TO BE CLASS"A"O12 BETTER
1. I have and will maintain a Certificate of ur
Conscnl to sel Finse for Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance orthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have mrd will maintain Worker'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,for the performance of the work for which this California health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Co lc,Section 25532(a)should I stare or handle hazardous
shall not croto n son in an manner so as to become subject to the mmerial.Additionally,should I use equipment or devices which emit hazardous
p y a y par y ) air contamhmnts as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 tied
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety
--- --
APPLICANT CERTIFICATION Date:B-15-2018
1 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 stale laws I hereby affirm that[here 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 ARCHITECT'S
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date B-15-2018
Professional