B-2018-1387 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1387
10367 SAN FERNANDO AVE CUPERTINO,CA 9501(357 12 004) RADIANT HOME
CONSTRUCTION LLC
CUPERTINO,CA 95014
OWNER'S NAME: DATE ISSUED:08/IC>/2018
OWNER'S PHONE: PHONE.NO:(
LICENSED CONTRAC'TOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lir.#85615
Contractor RADIANT HOME CONSTRUCTION LLC Dale 03/31/2019 X BLDG X ELECT_PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby xl'lirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)TEMPORARY POWER POLE-(100 AMP)
I hereby affirm under penalty of perjury one of the following two declarations:
f. 1 have and will maintain a certificate of conscut to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insnrome,as provided for by
,^ Section 3700 ofthe Labor Cade,for the performance of the work for which this
permit is issued. - - Sq.Ft Fluor Arca: Valuation:$5000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
into rmatlon 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 357 12 004
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 I(abilltles,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue galnst Bald C'ty Inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, he applicant understands and will comply with all non-point
source regain Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Dale 08/1 612 01 8 Issued by:Jasmine Archbold
Date:08/16/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt Brom Bre Contractor's License Law for one ofthe RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a or is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining on inspection,l agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
,at.(Sce.7o44,Business&Professions Code)
z. L as owner ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to briannot the project(Sec.7044,Business&Professions Code). Date:08/16/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 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 ofthe 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 peril is issued,l Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the n aterinl.Additionally,should I use equipment or devic,�``'which emit Imzardous
contaminants as detiued by the B rei Air Q IltdMnnagement District I
Worker's Compensation laws of California.If,after making this certificate of will couintuin compliance with the Cu n dre M pa Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S tions 25505,2 533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data:0 811 61201 8
1 certify that I have read this application and slate 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 DEClic reLARATION
Code,Section 9.18. 1 understand my plans shall be used as pubcords.
Licensed
Signature Date 0 811 6/2 01 8 professional