B-2018-1123 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1123
874 COTTONWOOD DR CUPERTINO,CA 95014-4623(369 18 010) BOB PEREZ
CONSTRUCTION
SAN JOSE,CA 95112
OWNER'S NAME:TUCKWILER PHYLLIS R TRUSTEE DATE ISSUED:07/03/2018
OWNER'S PHONE: PHONE NO:(408)646-8504
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.4648865
Contractor BOB PEREZ CONSTRUCTION Dale 07/31/2020 x BLDG_ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing _MECH 7X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMODEL BATHROOMS(2)LIKE FOR LIKE(80 SF);REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: WINDOWS LIKE FOR LIKE,SAME LOCATION(2)
r. 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 Code,for the
performance ofthe work for which this permit is issued.
l� z. I have and will maintain Worker's Compensation Insurance,as to for by
Section 3700 of the Labor Code,for the performance of the work fmwhich this
permit is issued. Sq.Ft Floor Area: Valuation:$20000.00
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 Nnnrber: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 19 10
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 perthe Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature / /// Date 07/03/2018 Issued by:Haley McKee
Date:07/03/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If roof is
t. I,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 fuspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(See.7044,Business&Professions Code), Date:07/03/2018
I hereby nfgnn under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L 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
pet fbrmanecofda,work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
it. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirenients 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, maintain compliance with the Cupertino Municipal Code,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 m to become subject to the material.Additionally,should I use equipment or devices which emft hazardous
.1,contaminants ns dented by the Bay Area Air Quality Management Dish•iet I
Worker's Compensation laws of California.If,atter making this certificate of will 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 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 CERTIFICATION Date:07/03/2018
I certify that I have read this application and slate that the above information is CONS'1'RDC'fION 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 families,
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
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07/0312018 Licensed
Professional