B-2018-1072 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1072
10745 N DE ANZA BLVD UNIT 107 CUPERTINO,CA 95014(326 26 034) AQUATEK PLUMBING
INC
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:06/26/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=36 Lic.#7i 7577
Contractor AQUATEK PLUMBING INC Date 09/30/2019 X BLDG—ELECT_PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I nm licensed tinder the provisions of Chapter 9(commencing
wif i Section 7000)of Division 3 of the Business&Professions Cade and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE 10 FT GAS LINE
I hereby aft7rm under penalty of perJury one of the following tiro declarations:
u. 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
perfnnanec 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 thework for which this
permit is issued. Sq.Ft Floor Arca: Valuation;$2825.00
APPLICANT'CEIi'fIFICATION
I certify that I have read this application and slate that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupaney'Iype:
and state laws relating to building construction,and hereby authorize 326 26 034
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 IIP WORK IS NOT STARTED
may accrue against said City in consequence of e-granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
AdditionaAH..
til understands d comply with all non-point
source rethe pe ino
"'pal
Code,Stiction 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 6-26-2018 Issued by:Kim Dunbar
Date:06/26/2018
O ER- BC& BATION
I hereby affirm that I em exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owuer of the property,o 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 structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. L,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Scc.7044,Business&Professions Cade). Data 66-26-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L I have and will maintain a Certificate of Consent to self-Insure for Walker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance fthe 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 ead the hazardous 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 Cade,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and fire
s. I certify that in the perfwntonce of the work for which this permit is issued,L Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to became subject to the
material.Additionnlly,should 1 use uipmenf m devices which emit hazardous
ontandnanta as defined by the
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 properly 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 9.1& 1 understand my plans shall be used as public records.
Licensed
Signature Date 6-26-2018 Professional