B-2018-1347-8-9-2018 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRAC'T'OR: PERMITNO:B-2018-1347
10573 CEDAR TREE CT CUPERTINO,CA 95014-2003(316 34 019) A-l HOME REPAIRS
INC
SAN JOSE,CA 95123
OWNER'S NAME: DATE ISSUED:08/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#921651
Contractor A-1 HOME REPAIRS INC Date 0 913 012 01 8 X BLDG ELECT—PLUMB
I hereby 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 fall force and effect JOB DESCRIPTION:
KITCHEN REMODEL(120 SF)
1 hereby affirm under penalty of perj Ory one of dm following two declarations:
r. 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 PI...Area: Valmltba:$15000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcatIon and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31634019
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,Judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,lhe-spplicant understands and will comply with all non-point
source rgulatlons pgr Cil ertl[no Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature � Date$-4-2018 Issued by:Kim Dunbar
Date:08/09/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 unr exempt from the Contractor's License Lew for one of the RF-ROOFS•
following two reasons: All roofs shall be inspected prior to any roofing material being installed If a roof is
r. I,as owner of the property,or my employees with wages as their,.In installed without first obtaining all 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)
2. I,us owner of the property,out exclusively contracting with licensed Signature of Applicant
contractors to construct the project(See.7044,Business&Professions Code), Date:8-9-2018
1 hereby of hon under penalty or perJ.,y one of tho following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
h. 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 fthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
z 1 have and will claimant Worker's Compensation Insurance,as provided far by I have read the hazardous materials requirements radon 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 Muulcipal Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I hor
ealth&Safety Cade,Section 25532(.)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to(he material.Additionally,should I use equipment or devices which emit hazardous
sir contaminants as dellned by the Bay Area Ah--%Qimtity Management District I
Worker's Compensation laws of Calffornin.If,ficrinaking this certificate of will maintain compliance with -Cuufer(in Mmur p.l Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation In of the the health&'I. Code,Secti n 25505,25533,and 25534,
Labor Code,I must forthwith comply with such provisions or this permit shall
he dcmncd revoked. Owner or authorized agent:
APPLICANT CEIi'1'IP[CA'1'ION Data:8-98-9-2018
1 certify that I have read this application and state that the above Information Is 'I'I. E DI G AGEN Y
correct,I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construe lending agency for the performance -
relating to building construction,and hereby authorize representatives of thls 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 comply with all non-point source regulations per the Cupertino MunicipalDECI,AR
ARS71I1'PEC'1"S A'11011
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 8-9-2018 Licensed
Professional