BLD-2020-1179 Permit12/3/2020
CITY OF CUPERTINO BUILDING PERMIT
021 BUILDING PERMIT
CUPERTINO
CITY HALL
1U3UU Foxe AvenU • Cupertino. CA 4501432$5
PHONE 408-777�22fl
wwW.CUPSM Q.ORG
C0N1&ACidR: STRAIGHT LINE GENERAL CONSTRUCT
DATE ISSUED 127 12= 4.4526 PM
JOB n_ ESC
NEW DETACHED A% (732 SF); COVER PCRCH (36'SF
LICNSEP CONTkAMR DECiARApON
CONTRACTOR: STRAIGHT nNE GENaAl. CONS 1R 11ON INC
EL GRANADA
: EXTERIOR WATER HEATER CLOSET
I APN; 34257 6T0 PERMIT No: BLD 2020-1179- ..
OWNER-. PHONE:
CONTRACTORPHONE:
IICENSEDCrASE: 6 GENERAL BUILDING COI ucerse°>ra'8626GI
up DATE: 0613012022
I hereby affirm that I am licensed under the provfeions of Chuprer 9 (commcmcina wish Section 70110) of Division 3 of the Business A professions Code aed HA y Frcense Is MhrU Farce and eFeat.
I herehy offs —under Denallyat perjury one of the Iolt.,ek, Iteee deelar K_
�I hove and All maintain a ccrtficote of consent to sekfmim,re rIX Warkers Compe-chw, as provided f0f by Sec?ion 3700 at the Labor Cade, for the MOm truce of the work forwhEch this permit is i,,aed_
I have and will main) —Workers Comm —tiara Mseronce, as pravidep for by5eclion 37OG ime labor Code, for fiseper€pmarrceo€ the walk far which this pemdt is isst 1
Ht cerfiry that in the performance of the —k for which this permit is issued I shell not employ any person in any manner m as to becomesubjecr to the Workers Componsorfan laws of Colrorab. if. ah- making twg cef1M cle or exemption. I
become wbjeal to the workers Compe_nsafian pmvid m of the Labor Code. I must forthvMh Comply with such provisions IX this pc+rmit 5hpp be deemedfevpPJ;tl.
HAZARDOUS MATERIALS DISCLOSURE
�I hava Mud fhe hazardous niaferiais mc[rr ements under Chapter 695 at fhe CGfifomla Heoflh 6 Sofa Code. vcfioru 25505 25533, and 25534. 1 ww mafntahl Compgonca wifh the Cupedino Municipal Co—tle• Ghppt �9. I2 and the Health 8
Solely Code.Secr-25522tol should l sti M or handio hazardous matedol. Addill—Ity, shoud I use equipmem a,devices which em6 haaardous pircaatar inanis - defineG by the Bay Area Air Q.okty Mpnagement Districl I wdl maintain
CjDM tanre wish the Cuperliftio Mwlkmg tCode, Chapfw 91.12 and the Health a 5ofely Cade. Sedans 25"'M 2553.3: a- 25534,
I:PA LEAD-SAFETASCLOSUBE "-
EIAn EPA Lead -Safe Ceffifred Rergvatwwill be fepanslde tar 111is protect.
Carff—i Firm Name:: '
Fnm CIXEficotion No:
EPA
I heeby offirn underpenahy of perjury, that there is a Canslr-ton lending agency for the pedamrence of the work AVh thh permit is awed f5eclian 3097. Ciol Code).
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❑Ya;� Na
Lentler.'s Name:'
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--------------------------------- Lemtlers Add ess:: ;
ArIFIXATION CERTIACAT10
I cedify feat I havere 1 fhis opp4calion and stale that the above information fs Cared. I agree to comply vrith all city and County—illnranoes —d slata T—ef'c3ing to buifdng constmr;pun, and hereby ouihorae representatives of this city to enfar
Upon
p hthe
eoobhve mentiurled properly for inspecfion purposes. Me) agree to save indemnify and keep fnxmless the City of Cupertino against Sobaifie;, judgemersts, costs. and expenses which may acave ogainIf said CUy in cansequerfce of the
gla8 penm6_Addifianally, the a ppiicont undefsta nds.and wit[ comply with all—;:, " sauree regulallons pertheCupertino M—ci pal Code. Secria n 9.1 a.
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https:llapps.cupertino.orglAccela/BLD-Sign-Permit.aspx?AceelaUser=ONETIMESIGN&OTK=Fci3LgN8gdFMLXQ2uVM]MsdddUQ80GQYQ5HvM2P6... 111