B-2018-0797 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS; CONTRACTOR: PERMIT NO:B-2018-0797
22056 WALLACE DR CUPERTINO,CA 95014-0128(326 03 041) PURONICS SERVICE
INC
LIVERMORE,CA 94551
OWNER'S NAME: DATE ISSUED:05/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-3fi Lip.#928595
Contractor PURONICS SERVICE INC Date 02/28/2019 X BLDG ELECT X PLUMB
I notchy affirm that 1 am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)INSTALL WATER SOFTENER SYSTEM
1 hereby affirm under penalty of perjury one of the following two declarations:
1. 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 Code,for On,
;performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided to r by
Section 3700 of the Labor Code,I'm'the performance of the work for which this
permit is issued, Sq.Ft Floor Area: Valuation:$3000.00
APPLICANTCERTIFICATION
I certify that I have read this application us late that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 32603 041
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 WORK 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 Cuperd -MV5 21 code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature h-fl9=2018 Issued b0 Kim Dunbar
Date:08//09/2018
OWNER-
I hereby affirm that I am exempt Train the Contractor's License Law for are of the RE-ROOFS
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a tool'is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree t remove all new materials fur
o..pensation,will do the work,and the sbvct ue is not intended or offered far inspection,
sale(Sec.7044,Business&Professions Cade)
z. I,as owner ofth,property,am exclusively contracting with licensed Signanne ofAppli-it:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05-09-2018
I hereby
nMrm under penalty.]'perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,m provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous matertots requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for.which thisCalifm ain Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. toalntain compliance With the Cupertino Municipal Code,Chapter 9.12 and the s. 1 certify that in the performance Health of the work for which this permit is issued,l nei &Safety Cade,Section 25532(a)should 1 store or handle hazardous
suntl not employ any person in any manner so as to become subject to the nair contaral.Additionally,should I use equipment or devices which emit huznrd.us
minants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
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 slhall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIIrICA'1'ION Date:05-09-2018
certify that have read this application and state that the above information is CONSTRUCTION
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,Civ C.)
toenter 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,
SignatureLicensed
Data 05-09-2018
Professional