HomeMy WebLinkAboutB-2017-1360 PermitCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1360
1527 POPPY WAY CUPERTINO, CA 95014-5306 (366 15 029)
MARTI'S PLUMBING
SERVICE
CUPERTINO, CA 95014
OWNER'S NAME:
PHONE NO: (408) 375-3190
LICENSED CONTRACTOR'S DECLARATION
BUILDING.PERMIT INFO:
License Class CC=36 Lic. #958020
Contractor MARTI'S PLUMBING SERVICE Date 02/28/2019
C BLDG —ELECT 3X PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
REPLACE SEWER MAIN; CLEAN-OUT; PROPERTY LINE
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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 have and will maintain Worker's Compensation Insurance, as provided for by
f- Section -3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $4500.00
permit is issued:
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
366 15 029
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,ag'ainst liabilities,, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK ISNOT STARTED
may accrue against'said City, in consequence of the granting of this 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.
L—i
Signatu J Date 08/16/2017
Issued by: Kim Dunbar
OWNER -BUILDER DECLARATION
Date: 08/16/2017
I hereby affirm that,I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. I, as owner of the' propertyor my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of tlie propeity, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct,the project (Sec.7044, Business & Professions Code).
Date: 08/16/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "All OR BETTER
1. I have and will maintaiti a Certificate of Consent to self -insure for Worker's
Compensation, ,asrprovided for by Section 3700 of the Labor Code, for the
performance' of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and 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. I will
'
is issued. ',
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit
I
s. I certify that m the of the work for which this is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
performance permit
shall not employ'any person in anymanner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality' Management District I
Worker 'sCompenkat ion laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption I become' subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code,'I mtist forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agen
APPLICANT CERTIFICATION
Date: 08/16/2017
I certify that I have read this application and state that the above information is
CONSTRU TION'I ENDING AGENCY
correct. I agree to comply with all! city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building corsteuction,I and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indernnify,and, keep harmless 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.
I understand my plans shall be used as public records.
Licensed
Signature Date 08/16!2017
Professional