HomeMy WebLinkAboutBLD-2019-0704_SignedPermit.pdfBUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 7398 ROLLINGDELL DR Cupertino
APN: 359 31 041
PERMIT NO: BLD-2019-0704
OWNER'S NAME: MAGELKY AUDREY L TRUSTEE
OWNER'S PHONE: Not Provided
CONTRACTOR:
PLUMBER HERO INC, 11 150 SEPULVEDA BLVD STE 2A MISSION HILLS
CONTRACTOR PHONE:
DATE ISSUED 8/15/2019 10:07:23 AM
ISSUED BY: HALEYM
VALUATION: $13000
JOB DESCRIPTION
LINE CLEANOUT; INSTALL (N) BUILDING CLEANOUT
SEWER LATERAL REPLACEMENT (45'); INSTALL (N) PROPERTY
LICENSED CONTRACTOR DECLARATION
CONTRACTOR, C36 PLUMBING, C42 SANITATION SYSTEM
Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
PLUMBER
LICENSED
A GENERAL
LICENSED
1028886
EXP
07/31/2021
I hereby
force
I hereby
HERO INC
CLASS:
ENGINEERING CONTRACTOR, B GENERAL BUILDING
NO:
DATE:
affirm that I am licensed under the provisions of
and effect.
affirm under penatiy of perjury one of the following
I have and will maintain a certificate of consent to
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,
I certify that in the performance of the work for which
laws of California. If, after making this certificate
with such provisions or this permit shall be deemed
three
self -insure
this
revoked.
declarations:
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
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under Chapter
the Health
Code,
for
project.
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12 and
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
the above
city to
costs,
-point source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this application and state that
construction, and hereby authorize representatives of this
harmless the City of Cupertino against liabilities, judgements,
the applicant understands and will comply with all non
Signature:
a
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 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.