B-2018-1346 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1346
20532 SHADY OAK LN CUPERTINO,CA 95014-0453(323 44 046) HOME DEPOT U S A
INC
ATLANTA,GA 30339
OWNER'S NAME: DATE ISSUED:08/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C17 C39 Q13 Lic.#M2331
Contractor HOME DEPOT U S A INC Date 09130/2018 X BLDG_ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Prufossions Code end that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE(3)WINDOWS LIKE FOR LIKE TO MEET EGRESS;
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL(2)PATIO DOORS
r. 1 have and will maintain a certificate of counal to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
per 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 tlic Labor Code,for the performance of fire work for which this
permit is issued. Sq,FT Floor Are,: Valuation:$10520.00
APPLICANT CERTHFICATION
I certify that I have read this appllcallon and slate that the above
Information Is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 323 44 046
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORI{IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE 012
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature .
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.Us roof is
1. 1,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the straeture is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec,7044,Business&Professions Code). Date:09(9[241$
1 hereby affirm under penalty of perjury one a]the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
11—and will mairwin a Certificate of Consent to self-insure far 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. HAZARDOUS MATERIALS DISCLOSURE.
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the Inzardaus materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Codd,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. nnintain compllanco with the Cupertino Muuluipal 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(a)should 1 store or trundle hazmdous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws ol'Califdrnia.If,after making thin certificate of contaminants as defined by the Bay Area Air Quality Management District 1
1 S 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 shall
be deemed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/9/2018
1 certify that I have read this application and state that the above information Is 4 ' U
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Isa04struction 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 comply with all nor-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 Data 08/9/2018 Licensed
Professional