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B-2017-0670CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0670 10300 TORRE AVE CUPERTINO, CA 95014-3202 (369 31 033) AVILA ELECTRIC HALF MOON BAY, CA 94019 OWNER'S NAME: CUPERTINO CITY OF OWNER'S PHONE: 650-245-8153 LICENSED CONTRACTOR'S DECLARATION ATION License Class C-10 Lic. #934752 Contractor AVILA ELECTRIC Date 06/30/2017 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -insure for Worker's ISSUED: 04/28/2017 PHONE NO: (650) 245-8753 BUILDING PERMIT INFO: X BLDG X ELECT PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: IRRIGATION CONTROLLER (110 OUTLET) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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: $1000.00 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 and state 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 harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations the Cupertino Mu . ipal Code, Section 9.18. Signature `> Date 04/28/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the propert); or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 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. s. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 and state 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 harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 04/28/2017 "N Number: Occupancy Type: 369 31 033 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: KIM DUNBAR Date: 04/28/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 04/28/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, ' ns 25505, 25533, and 25534. 1� Owner or authorized agent: ' Date: 04/28/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional GENERAL PERMIT APPLICATION E 0 FNft COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUA—ERTININO (408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.orgMISC 9 201 -71� ❑ PLUMBING ❑ MECHANICAL > ELECTRICAL ❑ MI SCELLANEOUS PROJECT ADDRESS APN® � -FG>R1FC- AOF 3 OWNER NAME PHONE Yv,– � AVJ 1/t Q753 -AZAc,L qE STREETADDRESS v//9 ( CITY pra I Gti ? / !Of FAX CONTACT NAME PHO 1 r - Z l� � EMAIL STREET ADDRESS �g � T/%'►I�� �' v irvt�V� CITY, STATE, ZIP FAX %OWNER ❑ OWNER -BUILDER ❑ OwNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENIGLNIEFR ❑ DEVELOPER TENANT CONTRACTOR CONTRACTOR NAME LICENSE NUMBER LICENSE T I V COMPANY NAME ,)--^� > i � ( !/1.w � Y 1 e— (� / EMAIL S✓ OVII C n S FAX STREET ADDRESS `?CSTS fes, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ ' MULTI -FAMILY BUII-DING: ❑ COMMERCIAL PROJECT AT NVILDLANU ❑ YES URBAN' INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ ]ES EICHLER HOME? ❑ NO DESCRIPTION OF WORK ?Mj4VA Y -)l Q jr V C-ovA1wtle� TOTAL VALUATION: o� REC By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signatmue of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED L4- - ❑ 01 ER -THE COUNTER - - t ❑ F_XPRESS c� ':❑ STAI\'I39RD U - < 0 LARGE TZA70R .MEPAlHscApp_�011.doc revised 06121111