HomeMy WebLinkAboutB-2018-0793CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0793
21957 OAKLEAF CTCUPERTINO, CA 95014-lt37 (326 18 066)
WILLOW GLEN
ELECTRIC INC
SAN JOSE, CA 95155
OWNERSNAME:
DATE ISSUED: 05/09/2018
OWNER'S PHONE:
PHONE NO (
LICENSED CONTRACTORS DECLARATION
BUILDING PERMIT INFO:
License Class C-1 0 Lic. #591918
Contractor WILLOW GLEN ELECTRIC INC Date 04/3012020
X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby ififfirm that I am licensed under the pi ovisions ofChapter 9 (commencing
—
with Sle,tion 7000) of Division 3 of the Business & Professions Code and that my
license Is I., fall Imerand effect.
JOB DESCRIPTION:
(N) EV CHARGING STATION (60 AMPS) - GAR -AGE
I hereby affirm under penalty offterjury one ofthe following two declarations:
r. I have and will insintrin a certificate ofconaent to self-insurc for Worker's
Compensation, as provided forby Section 3700 afthe Labor Code, for (lie
ponformance ofthe work for which [his permit is issued.
have and will anaintain Worker's Comp -action hasocalce, RS provided foo by
Section 3700 ofthe Labou Code, for tile perforruence oftlic, work for which this
permit is issued.
Sq. Ft Fla.,- Arco:
Vithantilin: $1940.00
APP I IFICATION
L-2MIMI
��
I certify that I have read t I stop 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 authorlze
326 18 066
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
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9. 1 B�
T.ON
I hereby affirm Hot I out —nifut from [lie Contractor's License Law fal one of tile
RE -ROOFS,
following tworesiono:
All ..I, sholl be ir,peeted iui.� to any no.fing ounciiel being installed. Its act I,
1, as owner ofthe property, at my employees with wages as then sole
installed without first obtaining oil insp=fion, I agree to rcanov, oil new materials fin
will do the work, and tile structure is not intended ci offered fin
inspection
Z'cosatilai,
17(Sce.7044, Business & Professions Code)
1, a, owner of the propeny, am exclusively coutt acting with licensed
Signature ofApplicant:
contractors to construct the project (Sce.7044, Business & Profession, Code),
Dats: 05/09/2018
1 hereby affirm order ],easily influrijilry mr, ififthe folowitig On . dia,kortitillic.
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 [law and will insintain a Certificate ofCousent to self hanee fou %Volker's
Compensation, as provided for by Section 3700 ofthe Labor Code, for the
performs— of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain Worker's Compensation Insurance, as provided lot by
I hava read the laryindous materials requirements Under Chapter 6.95 ofthe
Section 3700 afthe Lobw Code, fial, die penforrunice ofthe work for which this
California thoilth & Safety Code, Sections 25505,25533, and 25534. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 1 certify that in the performance ofibe work for which this perunil is issued, I
thadth & Safety Coule, Section 25532(a) should I store or handle huarclous
shall not employ any person in any overner so as to becolue subject to the
material. Additionally, should I time equipment a,- devices which inuff haroirdions
air contrunninmitsus defilled by the Bay Arco At,- Quality Management District I
exemption, I bwome subject to the Worker's Compensation provisions of tile
11111 maintain ellarildhince with the Cupertino Municipal Code, Chapter 9.12 and
tile Health & Safety
Labor Code, I must forthwith comply with such provisions or this permil shall
V25
be (learned revoked,
Owner or authorized agent
APPLICANTCERT
Data: 0510912018
�,.—.�"Ibsdlbr and li�FICATION
I certify that I have read I ate that the hove information is
CONSTRUCTION LENDING AGENCV
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
Leader's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-poin(source regulations par the Cupertino Municipal
ARCHII I"S DECLARATION
Code, Section 9.18.
1 understand my plans shall be J as public records.
Signature Date 05/09/201
Licensed
Professional