B-2018-1391 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CON'1'l2ACTOR: PERMIT NO:e-2018-1391
18641 MEDICUS CT CUPERTINO,CA 95014-3821(375 26 004) ALL PRO REPIPES INC
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:08/17/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lic.#0 7C
Contractor ALL PRO REPIPES INC Dale 01/31/2019 X BLDG—ELECT X PLUMB
I hereby affirm that I am lcensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIA —COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is to fall farce and effect. JOB DESCRIPTION:
RE-PIPE SFD FULL-COPPER
I hereby affirm under penalty of perjury one ol'the following two declarations:
t. 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
Parfet mance of the work for which this permit is issued,
I have and will maintain Worker's Compensation Insurance,as provided Por by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valuation:$10000.00
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 375 26 004
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 II bilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORT{IS NOT STARTED
may accrue against said ty in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the appy/'a understands and will comply with all non-point
source regulation upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/17/2018 Issued by:Jasmine Archbold
Date:08/17/2018
OWNER BUILD DECLARATION
I hereby atHrm hatI am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roof's shall be inspected prior to any roofing material being installed.If a roof is
r. 1,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 stricture is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sce.7044,Business&Professions Code). Date:08/17/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERr. 1 have and will maintain a Certificate o£Consent to self-insure tar 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
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardans materials requirements order 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 2550'25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Munidp 1 Cade,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,l Health&Safety Code,Section 25532(x)shrub I store r handle hazardous
shill not employ any person in any manner so as to become subject to the
material.Additionally,shunld f use t ipment r devices which emit hazardous
in contaminants as defined by the Ba r Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain cam fiance with the C �o mild al Code,Chapter 9.12 and
exemption,1 become subject to the Worker's Compensation provisions of the the Health&Safety Cod
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that(here is a constructlol ficipffing agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(t .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 ARCTIITEC'1'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 48/17!2018 Licensed
Professional