BLD-2020-0628BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: undefined
APN: 356 15 024
PERMIT NO: BLD-2020-0628
CONTRACTOR:
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CONTRACTOR PHONE:
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DATE ISSUED 8/13/2020 1:13:50 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $75000
JOB DESCRIPTION
ONE STORY ADDITION (320 SF); INTERIOR REMODEL (690 SF). (ORIGINAL PERMIT B-2019-0704 SEE COMMENTS)
DEMOLISH NON -PERMITTED COVERED PATIO AND CONSTRUCT
LICENSED CONTRACTOR DECLARATION
9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
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LICENSED
undefined
LICENSED
undefined
EXP
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I hereby
force
I hereby
CLASS:
NO:
DATE:
affirm
and effect.
affirm
I have and
for which
I have and
I certify that
with
that I am licensed under the provisions of Chapter
under penatiy of perjury one of the following
will maintain a certificate of consent to self
this permit is issued.
will maintain Worker's Compensation Insurance,
three declarations:
-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for
the performance of the work for which this permit is
so as to become subject to the Worker's
provisions of the Labor Code, I must forthwith
V
issued.
in the performance of the work for which this permit is issued, I shall not employ any person in any manner
laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation
such provisions or this permit shall be deemed revoked.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chatter 9.12 and the
V
with
equipment
Municipal
Health & Safety Code, Section 25532(a) should I store or handle
hazardous material. Additionally, should I use
I will maintain compliance with the Cupertino
or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District
Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
for this project.
Firm Certification No:
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which
this permit is issued (Section 3097, Civil Code).
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
Lender's Address:
V
Lender's
Name:
APPLICATION CERTIFICATION
above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this application and state that the
construction, and hereby authorize representatives of this
harmless the City of Cupertino against liabilities, judgements,
the applicant understands and will comply with all non -point
Signature:
days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.