BLD-2020-1405BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20200 LUCILLE AVE APT 117 CUPERTINO
APN: 316 02 094
PERMIT NO: BLD-2020-1405
CONTRACTOR: CORNERSTONE SELECT BUILDERS INC, 76 WRIGHT BROTHERS AVE FL 1 LIVERMORE
CONTRACTOR PHONE:
DATE ISSUED 9/9/2020 8:05:41 AM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $45000
JOB DESCRIPTION
(8); REPLACE (3) WINDOWS AND (1) SLIDER; (N) 100 AMP SUB -PANEL; KITCHEN REMODEL (88 SF); BATHROOM REMODEL (165 SF); REMODEL
(N) FURNACE AND A/C UNITS; SEE MASTER PLAN PERMIT B-2019-0090 FOR DRAWINGS
VERANDAS - UNIT 117- RE -PIPE ENTIRE UNIT
OTHER (122 SF); (N) LED LIGHTING (15 TOTAL);
LICENSED CONTRACTOR DECLARATION
INC
the provisions of
one of the following
of consent to
Insurance,
the work for which
making this certificate
shall be deemed
Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
LICENSED
EXP
I hereby
force
I hereby
CORNERSTONE SELECT BUILDERS
CLASS: Could not retrieve LP info.
NO: 888881
DATE: Could not retrieve LP info.
affirm that I am licensed under
and effect.
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of
laws of California. If, after
with such provisions or this permit
three
self -insure
this
revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
9.12 and the
Health
Code,
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
le
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm is
Certified
v
CONSTRUCTION LENDING AGENCY
that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and
state that the
of this
judgements,
with all non -point
above
city
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that
construction,
harmless
the applicant
Signature:
I
the
have read this application
and hereby authorize representatives
City of Cupertino against liabilities,
understands and will comply
.