BLD-2020-09982 BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 96014,3255
PHONE -7-3228
WWW,CGPER40877TIN0.ORG
BUILDING ADDRESS:
19608 PRUN�
APN:31645016
PERMIT NO:BLD-2020-0998
OWNER'S NAME:
OWNER'S PHONE: Not Provided
CONTRACTOR:
PACIFIC PLUMBING & El
CONTRACTOR PHONE:
�o
4088949120
DATE ISSUED 7/13/2020 9:56:57 AM ISSUED BY: KDUNBAR
VALUATION: $4111
JOB DESCRIPTION
ARIOSO APARTMENTS - BLD #4 - APT#4101-4308 - INSTALL SEISMIC EMERGENCY GAS VALVES ON ALL HOUSE LINES BY THE GAS METERS f 24j
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: LICENSED CLASS: LICENSED NO: EXP DATE:
PACIFIC PLUMBING & L C36 PLUMBING, A GEM 745976 05/31/2022 �
[ hereby affirm that [ 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 penally of perjury one of the following three declarations:
11
have and will maintain a certificate of consent to self -insure for Workers Compensation, as provided for by Section 3700 of the Lahor Code, for the performance
of the work for which this permit Is issued.
have and will maintain Workers Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this
ermlt Is issued.
I certify that In the performance of the work for which this permit is issued, I shol€ not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certlFicote of exemption, I become subject to the Workers Compensation provisions of the Labor Code, I must
Forthwith comply with such provisions or this permit shol€ be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
✓
I have read the hazardous materials requirements under Chapter 6.95 of the California Peo[lh & Safely Code, Sections 25505. 25533 and 25534.1 will me[ntain
compliance w11h the _Cupertino Muncipal C" ;
p of Code Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous matedaf.
Additionally, should I use equipment or devices which emit hazardous air centominanfs as defined by the Bay Area Air Quality Management District I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
EPA LEAD -SAFE DISCLOSURE
An EPA Lead -Safe Certified Renovator will be responsible for this project,
_. ----••-, ----------•--•--•--•...........................„
Certified Firm Name:: Firm Certification No::
`-•--•••------•••-------------•-----•..,............-..,................ --•-........................
No EPA Lead -Safe Certified Firm Is required for this project.
CONSTRUCTION LENDING AGENCY
l hereby offirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permli is issued (Section 3097, Civil
Code).
Yes [ No ...............
Lenders Name:; Lenders 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 laws relating
to bu€ld[ng construction, and hereby authorize representatives of this cIly to enter upon the above mentioned property for inspection purposes. l agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgements, costs, and expenses which may accrue against sold 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, Sccliun 9.18.
Signature:
/