B-2018-1218 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1218
22981 STONEBRIDGE ST CUPERTINO,CA 95014-5640(342 13 017) WATER QUALITY
PLUMBING INC
SAN JOSE,CA 95125
OWNER'S NAME:JALBERTCHRISTOP14ERP DATE ISSUED:07/18/2018
OWNER'S PHONE: PHONE NO:(408)267-9330
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lic.#305018
Contractor WATER QUALITY PLUMBING INC Data 02/2 912 02 0 X BLDG_ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(—imencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is I.fall force and effect. JOB DESCRIPTION:
REPLACE WATER LINE-ALL LANDSCAPE AREAS
1 hereby affirm under penalty of perjury one of dm following five declarations:
t. 1 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
,Scetion 3700 of the Labor Code,for the performance of the work fm which this
permit is issued. Sq.Ft Floor Arca: Valuation:$3800.00
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 342 13 017
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 u ds and will cc with all non-point
source regulations per the Cu tin i ipe
I Co e, ct'ion 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatc _ ate 07-18-2018 Issued by:Kim Dunbar
Date:07/18/2018
OWNER-BUILDER DECLARATION
I hereby uMrm tont 1 am exempt from the Contractor's License Law for one of the RE-ROOFS-
following for reasons; All roofs shall be inspected prior to any roofing material being installed.If a roof is
a. 1,as owner 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
ompersation,will do the work,and the structure is not intended or offered for inspection,
sale(Sec.7044,Business&Professions Cade)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicaut:
contractors to construct the project(Sm.7044,Business&Professions Code). Date:07-18-2018
I hereby affirm under penalty of perjury one of the following three dedritutions: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-insure Por Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work far which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of die work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. m aiatain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material,Additionally,should 1 use equipment or devices which emit hazardous
ir contaminants ns dented by the Bay Area Air Quality Nlanagenient District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Munlclpal od hu,E 'I ud
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25 d 25534,
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: _
APPLICANT CERTIFICATION Date:07-18-2018
I certify that I 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.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnifyand 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 DE iARATION
Code,Section 9.18. 1 understand my plans shall be used es public records.
Signature Date 07-18-2018 Licensed
Professional