11080064 REV1 I.1Cvtt ,r •-
CITY OF CUPERTINO BUILDING PERNi9E
BUILDING ADDRESS: 20488 STEVENS CREEK BLVD UNIT 2215 CONTRACTOR:GUfHRIE ELECTRIC INC PERMIT NO: 11080064
OWNER'S NAME: DEBORAH SAULT 605 COMMERCIAL ST DATE ISSI IED:08/08/2011
OWNER'S PHONE: 6509682425 SAN JOSE,CA 95112 PHONE NO:(408)536-0428
LICENSED CONTRACTOR'S DECLARATION (� r— r
n BUILDING PERMIT INFO: BLDG ELECT PLUMB
'•`L;icenseGlaasQ401:.,,8�..:ur mw°Lio''arwaen..r �'/' �Qrr.:,.:,.,,..
Date MECH r RESIDENTIAL r COMMERCIALContracr
1 hereby aff�m h 1 em licensed"under therovisions of Chapter 9 �/
p JOB DESCRIPTION: INVESTIGATION AND REPAIRS ON EXTERIOR DECK AS
(commencing with Section 7000)of Division 3 of the Business&Professions NEEDED.ANY STRUCTURAL COMPONENT REPLACEMENT
Code and that my license is In full force and effect. REQUIRES A REVISION 1'0 THIS PERMIT.
I herebyaffirm under penalty of 11/03/101 I-REVBI-DECK REPAIR AT CONDO PODIUM,REPLACE CURB&EDGE&
p y perjury one of the following two declarations: STUD CORNER-REV ISS'D 11/032011
1 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: Valuation:$9000
APPLICANT CERTIFICATION
I cenify that I have read this application and state that the above information is APN Number:36953049.00 Occupancy Type:
correct. I agree to comply with all city and county ordinances and slate laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep hamlessthe City ofCupertino against liabilities,judgments. PERMIT EXPIRES IF WORT{ IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section
9.1 180 DAYS FROM LAST CALLED INSPECTION.
8.
1..;�SiatureStgnaturec, di yfn. -a,. ylli,i(,gid�,, Date blr-ern .ru.:.,.rftr -ar r 1i16dk�hid�,. .uDate
Date Issued by:
OWNE -R DER DECLARATION
affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material berg installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant:_ Date:
construe(the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three AL1.ROOF COVERINGS TO RE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA%ARDOUS MATERIALS DISCLOSURE
MATERIALS DISCLOSURE
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 read the hazardous nsterials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must g�
forthwith comply with such provisions or this permit shall be deemed revoked. Owne �au zed agent: --
1.-..moi
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and stale that the above information is
correct.I agree to comply with all city and county ordinances and stale laws relating I hereby affirm that there is a construction lending agency for the performance of cork's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
11 non--point source reaulmims per the Cupertino Municipal Code,Sectim ARCHITECT'S DECLARATION
0
I understand my plans shall be used as public records.
Signature Date
Licensed Professional