BLD-2020-162610/29/2020
CITY OF CUPERTINO BUILDING PERMIT
BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 1048 WEST HILL CT Cupertino
APN: 362 27 044
PERMIT NO: BLD-2020-1626
OWNER'S NAME:
OWNER'S PHONE:
CONTRACTOR: BUILD UDREAM BUILDERS, 950 SOUTH FAIRFAX AVE #343 LOS ANGELES
CONTRACTOR PHONE:
DATE ISSUED 10/29/2020 1:42:36 PM
ISSUED BY: JASMINE ARCHBOLD
VALUATION: $8000
JOB DESCRIPTION
REMODEL KITCHEN - (39 SF) LIKE FOR LIKE
LICENSED CONTRACTOR DECLARATION
LICENSED NO: 1066990 EXP DATE:
COI 07/31/2022
with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force
CONTRACTOR:
I hereby
and
I hereby
affirm
effect.
affirm
I have and
this permit
have and
I certify
permit shall
BUILD UDREAM BUILDERS LICENSED CLASS:
B GENERAL BUILDING
that I am licensed under the provisions of Chapter 9 (commencing
under penatly of perjury one of the following three declarations:
will maintain a certificate of consent to self -insure for Worker's
is issued.
will maintain Worker's Compensation Insurance, as provided for
that in the performance of the work for which this permit is issued,
If, after making this certificate of exemption, I become subject to
be deemed revoked.
Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for
which
by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws
the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or
XI
of California.
this
HAZARDOUS MATERIALS DISCLOSURE
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the
I have read the hazardous materials requirements under Chapter 6.95 of the
Municipal Code, Chapter 9.12 and the Health & Safety Code, Section
X
Cupertino
25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices
Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
which emit hazardous air contaminants as defined by the Bay Area Air Quality
the Health & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
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I
Firm Certification No: :
;
An EPA Lead -Safe Certified Renovator will be responsible for this project.
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I 1
Firm Name: : ;
EPA Lead -Safe Certified Firm is required for this project.
Certified
XNo
CONSTRUCTION LENDING AGENCY
for the performance of the work which this permit is issued (Section 3097, Civil Code).
r
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction lending agency
No
' ;
X
Lender's
Name:
APPLICATION CERTIFICATION
correct. I agree to comply with all city and county ordinances
above mentioned property for inspection purposes. (We)
may accrue against said City in consequence of the
Municipal Code, Section 9.18.
and state laws relating to building
agree to save indemnify and keep harmless
granting of this permit. Additionally, the applicant
I certify that I
construction,
the City of Cupertino
understands
Signature:
have read this application and state that the above information is
and hereby authorize representatives of this city to enter upon the
against liabilities, judgements, costs, and expenses which
and will comply with all non -point source regulations per the Cupertino
Every
days
within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 365
permit issued shall become invalid unless the work on the site authorized by such permit is commenced
after the time the work is commenced.
,
Submit
https://apps.cupertino.org/Accela/BLD-Sign-Permit.aspx?AccelaUser=ONETIMESIGN&OTK=OXkKhVhk3fg3gWnFsaeAeaRhXUiF4sNWGXE2w2rSy5... 1/1