B-2018-0773 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0773
19140 STEVENS CREEK BLVD APT C104 CUPERTINO,CA 95014-2573(375 07 060) OVERMILLER INC
CONCORD,CA 94520
OWNER'S NAME:STEVENS CREEK VILLAGE,IN C. DATE ISSUED:05/07/2018
OWNER'S PHONE: PHONE NO:(925)798-2122
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lie.4323839
Contractor OVERMILLER INC Date 07/3112018 X BLDG ELECT X PLUMB
I hereby affirm that I am licensed ander 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. SOB DESCRIPTION:
REPLACE 40 GAL WATER HEATER(SAME LOCATION)
I hereby affirm under penalty otperjnry one of the following five 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 the
performance of the work for which this permit is issued.
�. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Fluar Area: Valuation:$1850.00
APPLICANT CERTI"CATION
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 slate laws relating to building construction,and hereby authorize 375 07 060
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 sold City in consequence of the granting of this permitWITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands will comply with all non-point
source regulations per the Cupertino unicipa Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 05-07-2018 Issued by:Kim Dunbar
Date:05/07/2018
WNER-BU116FR DECLARATION
I hereby affirm that I am exempt train[he Contractor's License Law fm.one of the RE-ROOFS•
following two reasons: All roof's shall be inspected prior to any roofing material being installed,if a roof is
t. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection,
sale(Sec.7044,Business&Professions Code)
z. 1,as owner of die property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:05-07-2018
f hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 have and will maintain a Certificate of Consent to self-insure for Win kai's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which thisCa Burnie Health&Safety Code,Sections 25505,25533,and 25534.1 will
inn
permit is issued. - aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(x)should I store or handle hazardous
shall not employ on in an manner so as to become sub;cet to the material.Additionally,Sluuld I use equipment u'devices which emit hazardous
p y any pets y air contaminants as defined by the Bay Arca Air Quality ItI�ilIs,i agemen strict I
Worker's Compensation laws of California.iF,after making this certificate of will maintain compliance with the Cupertino Municipal Ca�tln CCha Or 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C Woos 25505,25533,an,23
Labor Code,1 must forthwith comply with such provisions or this permit shall _--
be deemed revoked. Owner or authorized a eat:
APPLICANT CERTIFICATION Data:05-07-2018
I certify that I have read this application and state that the above information is C N TR ENDI CY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a const tion 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.)
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 complywith 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.
Signature Date 05-07-2018 Licensed
Professional