Loading...
HomeMy WebLinkAboutB-2018-0987G CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0987 22459 PALM AVE CUPERTINO, CA 95014-2711 (357 03 073) HALL MICHAELAND MARIA Z 22459 PALM AVE CUPERTINO, CA 95014-2711 OWNER'S NAME: DATE ISSUED: 06/11/2018 OWNER'S PHONE: PHONE NO: Nona LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor HALL MICHAEL AND MARIA Z Date X BLDG X ELECT _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 o the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL (8) RECESSED LIGHTS AND (1) PLUG 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 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation hasmance, 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: $600.00 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 35703 073 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 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. Signature Date Issued by: Jasmine Archbold OWNER DECLARATION Date: 06/11/2018 -BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is TI, as owner of the property, or 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 (Sm.7044, Business & Professions Code) z I, as owner of [he property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER L 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 Cade, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 1 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I wW 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 25 OS - 33,33, and 25534 Labor Code, I must forthwith comply with sub provisions or this permit shall be deemed revoked. ///, Owner or authorized agent: APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information Is CONSTRUCTION LENDING 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 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 above mentioned property for inspection purposes. (We) agree Lender's Name to save Indemnify 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 -poi source regulatlons vthe Cupertino unI IpaI ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. � �/j' /�/� Licensed Signature Date f/ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22459 PALM AVE CUPERTINO, CA 95014-2711 (357 03 073) OWNER'S NAME: OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Hall Michael And Maria Z Date 1 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: r. 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. 2. f 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. 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 10/04/2018 OWNER -BUILDER DECLARATION 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 property, 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) 2. 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: 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. z. 1 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. 3. I 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 CONTRACTOR: PERMIT NO: B-2018-0987 Hall Michael And Maria Z 21131 RAINBOW DR 22459 Palm Ave Cupertino, CA 95014- 2711 DATE ISSUED: 06/11/2018 PHONE NO: BUILDING PERMIT INFO: X BLDG X ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: INSTALL (8) RECESSED LIGHTS AND (1) PLUG REV # 1 ADD (3) PLUGS - ISSUED 10/04/2018 Sq. Ft Floor Area: I Valuation: $600.00 APN Number: Occupancy Type: 357 03 073 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Archbold Date: 06/11/2018 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Appl Date: 10/04/2018 ALL ROOF COVERINGS TO BE CLASS "A" 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. 1 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, 533, a 25534. Owner or authorized agent. Date: 10/04/2018 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.