B-2017-0371CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0371
10161 LEBANON DR CUPERTINO, CA 95014-2645 (342 14 007)
TITAN GENERAL
CONSTRUCTION INC
FREMONT, CA 94539
OWNER'S NAME:
PHONE NO: (408) 883-8668
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #948867
Contractor TITAN GENERAL CONSTRUCTION INC Date 06/30/2018
X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that 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.
JOB DESCRIPTION:
CONSTRUCT (I) 2 STORY SFD (3975 S.F.); ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
(447 S.F.); PORCH (774 S.F.)
2: I have and will maintain a certificate of consent to self -insure for Worker's
(ATTACHED,2ND UNIT B-2017-0372)
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
Sq. Ft Floor Area: 3975
Valuation: $700000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws,relating to building construction, and hereby authorize
342 14 007
R-3 (Custom)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting ofthis'permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all. non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature�� Date 07-24-20107
Issued by: Kim Dunbar
UWNER-BURDER'DECLAR ATION
Date: 07/24/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. 'I, as owheiof the property, or my employees with wages as their sole
installed without fust obtaining an inspection, I agree to remove all new materials for
competisation, will do the work, and the structure is not intended or offered for
inspection.
(sale (Sec.7,044, Business & Piofessions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
comfaotors to construct the project (Sec.7044, Business & Professions Code):
Date: 07-24-20107
i,
I hereby affirmi under penalty of perjury one of the following three declarations:
"A"
1. I have andlwill, aintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance'of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 have andi will'maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of•the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505,, 25533, and 25534. 1 will
'I ' '
permit issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
. I'
3. I certify that in the performance of the work for which this permit is issued, I
I„
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall'not employ any person in any manner so as to become subject to the
. � i I,
Workerls Compensation Iawsiof California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
the Cupertino Municipal Code, Chapter 9.12
exemption, I become subject to the Worker's Compensation provisions of the
ill maintain compliance with and
the Health & Safety Code, tions 505, 33, and 25534.
Labor Code,,l must forthwith lcomply with such provisions or this permit shall
be deemed revoked.
Owner or authorized age
APPLICANT CERTIFICATION
Date: 07-24-20107 `
I certify that I have read this appllcation,and state that the above information is
correct. I agree to comply with all61i ' and county ordinances and state laws
CONSTRUCTION'LENDINGAGEtiCY
I hereby affirm that there is a construction lending agency for the performance
relating to building construction,^and, hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the.i above mentioried property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep Wrhless'the City of Cupertino against liabilities,
judgments, costs; and,expenses which may accrue against said City in
Lender's Address
consequence of the granting of,this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 07-24-20107
professional