B-2018-1033 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1033
10970 MARIA ROSA WAY CUPERTINO,CA 95014-4720(356 18 005) HOME DEPOT U S A
INC
ATLANTA,OA 30339
OWNER'S NAME:WILSON WILLIAM M AND LINDA L TRUSTEE DATE ISSUED:06/18/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INTO:
License Class @ Lie.#602331 X BLDG—ELECT—PLUMB
Contractor HOME DEPOT U S A INC Date 09/30/2018 —
MECH X RESIDENTIAL COMMERCIAL
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 fun force and effect. JOB DESCRIPTION:
INSTALL INSULATION-ATTIC(R13)(1600 SF)
I hereby offirm 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 Cade,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 die performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$3184,00
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 All Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 18 005
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 / Data 06-18-2018 Issued by:Kim Dunbar
Date:06/18/2018
' -BDILDER DELL 'PI
I hereby affirm that I am exempt from the Contractor's License Law for one of theli OFS:
Following two reasons: All roofs shall be inspected prior to any roofing material being installed.If. .or 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 materiala for
compensation,will do the work,and the structure is not intended of offered for inspection.
side(Sec.7044,Business&Prefessitu s Code)
z. I,as owner of the property,am exclusively.-trotting with licensed Signature:dApplicant:
contractors to construct The project(Sec.7044,Business&Professions Code), Date:06-I8-2018
I hereby affirm under penally of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,Far the
performance of due work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requh ements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which thisCalifornia Health&Safety Code,Sections 25505,25533,and 25534.t will
t is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
pct"m Health&Safety Cade,Section 25532(a)should 1 store or handle hazardous
s. f certify teal in they person in of the work so
which this penult is issued,l material.Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject[e the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California,11',aver making this certificate of will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the fee Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent--
APPLICANT
gentAPPLICANT CERTIFICATION Date:06-18-2018
I certify that I have read this application and state that the above information Is LMSIRIKE10NCZENCV
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
consequenceof 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.
Signature Date 00-18-2018 Licensed
Professional