B-2018-1112 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1112
1087 S STELLING RD CUPERTINO,CA 95014-5018(362 22 002) ROOTER HERO
PLUMBING INC
MISSION HILLS,CA
91346
OWNER'S NAME:Raw Mary DATE ISSUED:07/02/2018
OWNER'S PHONE: PRONE NO:(088)929-4376
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=36 Il#973014
Contractor ROOTER HERO PLUMBING INC Date 05/31/2020 X BLDG—ELECT X PLUMB
I hereby affirm that I am 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 fall force and effect. JOB DESCRIPTION:
REPLACE WASTE LINES UNDER THE HOUSE
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.
,a 1 have and will maintain Worker's Compensation Insurance,as provided for by
✓7 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Flaor Area: Valuation:$8000.00
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 APN Number: Occupancy Type:
and stale laws relating to building construction,and hereby authorize 362 22 002
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 appi ca t understands and will comply with all non-paint
source regulatio r6 per he Cupertln Municipal Code,Section 9,18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/02/2018 Issued by:Jasmine Archbold
Data:07/02/2018
OWNER-BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROO
wo FS•
following trenamoi: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner fthe property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
onrpensation,will do the work,end the structure is act intended or offered far inspection.
sale Sec.7044 Business&Professions Codc
z I,as owner Ortho property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec,7044,Business&Professions Code). Date:07/02/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL RODE COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of thework£orwhich this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I(rave read the hazardous materials requirements under Chaplet 6.95 of the
Section 3700 of the Labor Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9,12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)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
.or..faminuuts as defined by the Bay AreaAir Quality Manage"'or District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cape
unid�jfalau 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the file Health&Safety CadeS'ecfio 5505, 34.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIFICATION Data:07/02/2018
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-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Cade,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07/02!2018 Licensed
Professional