HomeMy WebLinkAboutBLD-2019-0724_SignedPermit.pdf UILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10140 STERN AVE Cupertino
APN:
375 12 008
PERMIT NO: BLD-2019-0724
OWNER'S NAME: DHINGRA RENEE AND GULATI PARVEEN
OWNER'S PHONE: Not Provided
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 10/9/2019 4:14:26 PM
ISSUED BY: HALEYM
VALUATION: $70000
JOB DESCRIPTION
RELOCATE PGE METER; NEW ELECTRICAL MAIN PANEL (200 AMPS);
FIRST FLOOR ADDITION (474 SF);
OWNER -BUILDER DECLARATION
perjury one of the following two
or my employees with wages as
am exclusively contracting with
perjury one of the following two
certificate of consent to self -insure
Compensation Insurance,
of the work for which this
If, after making this certificate
permit shall be deemed revoked.
declarations:
their role compensation, will do the work, and the structure
licensed contractors to construct the project (Sec. 7044,
is not intended or offered for sale (Sec. 7044. Business
I hereby
affirm under penatly of
I, as owner of the property,
Code).
le
& Professions
Business & Professions Code).
I, as owner of the property,
affirm under penatiy of
I have and will maintain a
for which this permit is issued.
I have and will maintain Worker's
I certify that in the performance
laws of California.
with such provisions or this
I hereby
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
Chapter
Sections
for
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, Chapter 9.12 and the Health
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
25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
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).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
representatives of this city
against liabilities, judgements,
will comply with all non -point
itLy
to
costs,
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
construction,
harmless the
the applicant
Signature:
have read this application
and hereby authorize
City of Cupertino
understands and
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.