B-2018-1306 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:B-2018-1306
1191 f PLACER SPRING CT CUPERTINO,CA 95014-5103(366 55 011) LOS ALTOS BUILDERS
MOUNTAIN VIEW,CA
94040
OWNER'S NAME: DATE ISSUED:08/02/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S BUILDING PERMIT INFO:
License Class C-10 Lid,#843863
Contractor LOSALTOS BUILDERS Date 08/31/2018 X BLDG X ELECT—PLUMB
[hereby nflL•m that 1 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 thnt my
license is in full force and effect. JOB DESCRIPTION:
REMODEL KITCHEN-(150 SF);INSTALL(6)RECESSED LIGHTS IN
I hereby affirm under penalty of perjury one of the following two declarations: LIVING ROOM
[
is issued. Sq.Ft Floor Area: Valuation:.$49000.00
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 state laws relating to building construction,and hereby authorize 366 55 Oil
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 jal---------PERMIT EXPIRES IF WORE{IS NOT STARTED
may accrue against said Cisyy In consequence of the gran lef is permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the app lic t`fiderstands and will cam 'tffalI non-point
source regulations of Cupertino Muni al ode, ction 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature
I hereby af'Br11AL rla-tl at I am exempt from the Contractor's License Lnw for site of file RE-ROOFS:
following two reasons: All roof's shall be inspected prior to any roofing material being installed.If a.of is
r. I,as owner of the property,m 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 ab ucmre is not intended or offered for inspection.
sale(See.7044,Business&Professions Code)
z I,as owner of the property,am exclusively contracting with licensed Signature ofApplicanC
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/02/2018
1 hereby affirm ander penalty of perjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTER
h. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,m provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the bazardous materials requirements 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. maf ltum complimace with the Cupertlnu Municipal Code,Chapter 9,12 and the
a. f certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Sectiou 25532(x)should 1 stare 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
xh•contaminants as defined by the Boy,Area,Air Quality Management District 1
Worker's Compensation laws of California If,after making this certificate of will maintain compliance with tjw,Cihperti a6 Municipal Code,Chnptcr 9.12 and
exemptiea,I become subject to the Worker's Compensation provisions o£thc the IleNth&Safct Code, tans 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deenhed revoked. Owner or authorized
)
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 ARCHFfECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 08/02/2018 Professional