B-2018-1373 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1373
632 PHIL CT CUPERTINO,CA 95014-4654(375 42 022) CUPERTINO
PLUMBING INC
SAN JOSE,CA 95124
OWNER'S NAME: DATE ISSUED:08/14/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 0-36 1#824905
Contractor CUPERTINO PLUMBING INC Date 04/30/2020 X BLDG_ELECT X PLUMB
1 hereby affirm that 1 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 fn fall force and effect. JOB DESCRIPTION:
RE-PIPE SFD(COPPER)-FULL
I hereby affirm under penalty of perjury one of the following two declarations:
n. 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
on-mire of the work£or which this permit is issued,
have and will maintain Worker's Compensation Insurance,as provided for by
'. cction 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$7000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcallon and stale 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 375 42 022
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
114/2018 Issued by:Jasmine Archbold
Date:08/14/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of rhe RE-ROOFSi
following two reasons: All roofs shall be inspected In to any reefing material being installed.If a.of is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining or inspection,l agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Cade)
1. I,as owner of the property,am exclusively contracting with licensed Signatare ofApplicane
contractors to construct the project(Sec.7044,Business&Professions Cade). Date:08/14/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided far 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 this California flealth&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. reainmin compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance ofthe 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 1 use equipment ar devices which emit hazardous
contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of wilmaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l became subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 255 25533,and 25534,
Labor Code,I moat forthwith comply with such provisions or this permit shall //.-
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 hablllties,
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 DECLARA'HOiN
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 08/14/2018 Licensed
Professional