B-2018-0892 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2018-0892
1673 GALWAY DR CUPERTINO,CA 95014-5240(366 24 028) COMET PLUMBING
AND SEWER
COMPANY
SUNNY-VALE,CA
94088
OWNER'S NAME: DATE ISSUED:05/23/2018
OWNER'S PHONE: PHONE NO:(408)502-0933
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lie.#951887 BLDG_ELECT x PLUMB
Contractor COMET PLUMBING AND SEWER COMPANY Date 09/30/2018
I hereby affirm that I am licensed under the visions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
pro p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
INSTALL PROPERTY LINE CLEAN-OUT;REPLACE l5FT OF PIPE
1 hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintains certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Cade,for the Pat tot of the work for which this
permit is issued. Sq.Ft Flom Area: Valuation:$6000.00
APPLICANT 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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 366 24 028
representatives of this city to enter upon the above mentioned property for
inspection purposes.(We)agree to save Indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORT{IS NOT STARTED
may accrue against said City in consequence of the granting of this permit WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino
xMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature - •- Date 05-23-2018 Issued by:Kim Dunbar
Date:0SY23/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Low for one of the RE-ROOFS:
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owner of die Property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the struchre is not intended or offered for o'q—tien.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to consarmt the project(See,7044,Business&Professions Code). Date:05-23-2018
I hereby affirm under penalty o1'perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER1. I Have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance ofthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
z 1 have and will maintain Worker's Compensation Insurance,as provided t'or by I have read the ha—h is materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.f will
permit is issued. m atntat.compliance with the CupertinoandMunicipal Code,Chapter 9.12 nthe
s. I certify that in die performance of the work for which this permit is issued,I health&Safety Code,Section 25532m)shmdd 1 store or handle hazardous
shall not employ an son in an anner so as to become sub'ec[to the material.Additionally,should I use equipment or devices which emit hazardous
�
-��exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05-23-2018 ,
I certify that I have read this application and state that the above information is CONSTRUCTIOSN LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Clv C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature,-- Date 05-23-2018