BLD-2020-1000BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue * Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
OWNER'S NAME: SFERS REAL EST CORP UU
OWNER'S PHONE: Not Provided
CONTRACTOR:
PACIFIC PLUMBING & E
CONTRACTOR PHONE:
LI
V B o ec(q — ci
17 0
DATE ISSUED 7/13/2020 9:05:58 AM
ISSUED BY: KDUNBAR
VALUATION: $41 11
JOB DESCRIPTION
ARIOSO APARTMENTS - BLD #6 - APT#6101-6309 - INSTALL SEISMIC EMERGENCY GAS VALVES ON ALL HOUSE LINES BY THE GAS METERS (27)
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: LICENSED CLASS: LICENSED NO: EXP DATE:
PACIFIC PLUMBING & E
C36 PLUMBING, A GENI
745976
05/31/2022
I hereby affirm 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.
I hereby affirm under penaHy of perjury one of the following three declarations:
1=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
of the
performance
work for which this permit is Issued.
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
ermit
Is issued.
I certify that in the performance of the work for which this permit is issued. I shall not employ any in any manner so as to become subject to the Worker's
Compensation
forthwith
person
laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code. I must
comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS
MATERIALS DISCLOSURE
Ili
have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections '25505. 25533. and 25534. I will maintain
compliance
with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(aj should I store or handle hazardous material.
Additionally,
compliance
should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain
with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
EPAPA
LEAD-SAFE DISCLOSURE
j
ElAn
Certified
EPA Lead -Safe Certified Renovator will be responsible for this project.
.
Firm Name: ; JIFirm Certification No:
Lila
EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil
Code).
El
Yes
I No
Lender's Name:: Lender's Address' :
APPLICATION 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 and state taws relating
to building construction, and hereby authorize 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. judgements, costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature: