B-2018-1208 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1208
21069 RED FIR CT CUPERTINO,CA 95014-4251(359 05 021) STREET PLUMBING
AND ROOTER
SAN JOSE,CA 95128
OWNER'S NAME:Nguyen He Phone And Ngo Hong Hoa Thi DATE ISSUED:07/17/2018
OWNER'S PHONE: PHONE NO:(408)496-1155
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMITINFO:
-
License Class C-M Lic.#5822U
Contractor STREET PLUMBING AND ROOTER Date 12/31/2019 X BLDG_ELECT X PLUMB
I hereby affirm that I 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 force and effect. JOB DESCRIPTION:
(N)40 GALLON WATER HEATER-SAME LOCATION AT THE
I hereby affirm under penalty of pm•jury one of the following two declarations: GARAGE
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.
1 have and
will
maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of lire work for which this
permit is issued Sq.Ft Floor Area; Valuation:$1600.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above
information is correct.I agree to comply with all city and county ordinances APN Nmnber: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 359 05 021
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 IIKN 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.
ignalure Data 07/17/2018 Issued by;Jasmine Archbold
Date;07/17/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I at,,exempt from the Contractor's License Law for one ol'theRE-ROOKS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If..of is
u 1,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,1 agree to remove all new moue ads for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,nsOwner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:07/17/2018
I hereby affirm under penalty ofperjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTER
t. 1 have and will maintain a Certificate of Consent to self-insure fou r Worker's
Compensation,as provided for by Section 3700 of the Labor Code,f'or the
performenec ofthe 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 requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which thisCalifornia Herddr&Safety Code,Seetions 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner ser as to become subject to the material Additionally,should 1 rise equipment or devices which emit hazardous
Worker's Compensation lows of California,If,alter making this certificate of air contaminants ns defined by the Bay41s
Are.Air Quality Management District 1
will maintain the Cr mineMunicipalCode,Chpter9.12and
emption,I become subject to the Workr's Compensation provisions of the theHealto , actions2550, 33,and25534Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorizAPPLICANT CERTIFICATION Date:07/17!2018
I certify that I have read this application and state that the above information is T 'correct.I agree to comply with all city and county ordinances and state laws I hereby affirm thatonstruction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which it 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
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 07!17!2018 Professional