BLD-2019-1332BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10660 S DE ANZA BLVD Cupertino
APN: 369 37 026
PERMIT NO: BLD-2019-1332
CONTRACTOR: SCOTT PAINE CONSTRUCTION INC, P 0 BOX 320008 CUPERTINOLOS GATOS
CONTRACTOR PHONE:
DATE ISSUED 9/15/2020 9:36:13 AM
ISSUED BY: haleym
VALUATION: $50000
JOB DESCRIPTION
ACCESSIBILITY UPGRADES
YIASSOO T.I. - (1161 SF) VOLUNTARY
LICENSED CONTRACTOR DECLARATION
INC
the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B.
LICENSED
EXP
04/21/2021
I hereby
force
I hereby
SCOTT PAINE CONSTRUCTION
CLASS:
NO: 653453
DATE:
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
one of the following three
of consent to self -insure
Insurance,
the work for which this
making this certificate
shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Co lie, 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
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
V
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 Code,
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 above
of this city
judgements, costs,
with all non -point source
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
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code. Section 9.18.
I certify
construction,
harmless
the
Signature:
that I have read this
and hereby
the City of Cupertino
applicant understands
application
authorize representatives
against liabilities,
and will comply
.