B-2018-1995 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1995
19540 VALLCO PKWY STE 160 CUPERTINO, CA 95014 (316 20 119) BOAZ RENOVATIONS
INC
NEWARK, CA 94560
OWNER'S NAME: DATE ISSUED: 11/21/2018
OWNER'S PHONE: PHONE NO: (408) 279-0300
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic. #943011
Contractor BOAZ RENOVATIONS INC Date 03/31/2019 X BLDG — ELECT — PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing —
MECH . . RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of penINSTALL (1) BLADE SIGN (SUL&BEANS); (1) BANNER SIGNury one of the following two declarations: (SOMISOMI); (1) BANNER SIGN (SUL&BEANS)
I have and will maintain. Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. Sq. Ft Floor Area: Valuation: $750.00
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 31620 1. 19
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agr,Cp to save indemnify and keep harmless the
City of Cupertino a ainstel' bili i s judgments, costs and e
p 9 , ) g expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against Coity A consequence of the granting of this permit..
Additionall , t e ap{ H a understands and will comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
r
pY p
source re ula Section 9. 18. 180 DAYS FROM LAST CALLED INSPECTI
Signature Date 11 .21 .18 Issued by: SEAN HATCH
Date: 11/21/2018
OWNER-BUILDER DECLARATION
I hereby aff rm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, 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 structure 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 (Sec,7044, Business & Professions Code). Date: 11.21.18
I hereby affirm under penalty of perjury'one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BET
1. I have and will maintain a Certificate of Consent to self-insure for Worker's TER
Compensation, as provided far by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 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 this California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the 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 I use equipme t or evices which emit hazardous
W r air contaminants as defined by the Bay Area A'' - (� ality Management District I
o ker s Compensation laws of California. If, after ma.king this certificate of Will maintain compliance with the Cup � n9 u'� � cipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety ode, , c i 25 X05, 25533, and 2 34.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. `
Owner or authorized agent:
APPLICANT CERTIFICATION Date: 11 .21 .18
I certify that I have read this application and state 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 DECLARATION
Code, Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 11 .21 .18 Professional