B-2018-0843 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0843
7553 HEATHERWOOD DR CUPERTINO,CA 95014-5840(359 26 056) CALIFORNIA
BUILDING
SOLUTIONS
FREMONT,CA 94538
OWNER'SNAME: DATE ISSUED:05/16/2018
OWNER'S PHONE: PRONE NO:(
IC' BUILDING PERMIT INFO:
License Class B Lio.#997028
Contractor CALIFORNIA BUILDING SOLUTIONS Date 09/30/2018 X BLDG_ELECT_PLUMB
I hereby al'lirm that 1 nm licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full furec and effect. JOB DESCRIPTION:
REMODEL HALL BATHROOM(104 SF)
I hereby nff3nn 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 per is issued.
z. I have and will maintain We. Compensation Insurance,as provided for by
1"6''actio n 3700 of the Labor Code,for the performance of the work for which this
Pei mit is issued. Sq.Ft Floor Area: Valuation:$12000.00
APPLICANT CERTIFICATION
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 AI'N Number: Occupancy Type:
and stale laws relating to building construction,and hereby authorize 359 26 056
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 WORT{IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMITISSUANCE 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 Data 0 5/1 612 01 8 Issued by:Jasmine Archbold
Date:05/16/2018
OWNER-BUII,DF.R DECLARATION
I hereby af'turm that I am exempt from the Contractor's License Law fee one.!'tile RE-ROOFS:
following hvo.anson a All roofs shall be inspected prior to any roofing material being installed.If.roof is
r. 1,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(S.,7944,Business&Professions Code)
z 1,as owner ofthe property,am exclusively contracting with licensed Signature af Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Dare:05/16/2015
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have and will maintain a Certificate of Consent to self-fnsure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,fur the
perfmotance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
x. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hnzurdous 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
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 4.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(a)should 1 store or handle hazardous
shallow employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air eontamfnauts as deBued by the Bay Arca Air Quality Mnnngement District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2Z5505,111_,and 25534.
Labor Code,1 moat forthwith comply with such provisions a this permit shall
be deemed revoked. Owner or authorized agent: —"`
APPLICANT C'aTIFICATION' Date:05/16/2016
I certify that I have read!his application and slate that the above Information is LONS'rRUCT'ION LENDING AG.NCV
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,casts,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 DECLARNT ON
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05/16/2018 Licensed
Professional