B-2018-1320 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1320
11702 WESTSHORE CT CUPERTINO,CA 95014-5148(366 53 019) AMERICAN
WINDOWS CENTER
INC
DALY CITY,CA 94015
OWNER'S NAME: DATE ISSUED:08/09/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONT ACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C-17 Lie.#875889
Contractor AMERICAN WINDOWS CENTER INC Date 04/30/2020 X BLDG ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(e mmeneing —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. JOB DESCRIPTION:
REPLACE WINDOWS(23)LIKE FOR LIKE TO MEET EGRESS;(1)
I hereby affirm under penalty ofperjury one of the following two declarations: SLIDING DOOR LIKE FOR LIKE
I. 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.
z. 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 Floor Aron: Vnluntion:St8450.00
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: Occuponey Type:
and state laws relating to building construction,and hereby authorize 366 53 019
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 understands and will comply with all non-point
source regulations per-eCthe Cupertino Municipal Code,Section 9.1 B. 180 DAYS FROM LAST CALLED INSPECTION.
Signature �----' 7tDate 08/0912018 Issued by:Jasmine Archbold
Data:08/09/2018
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for ane of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to nny roofing material being installed.t£a.of is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will de the work,and the structure is not intended or offered for importer,
snlc(Scc.7044,Business&Profcssimts Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:08/09/2018
1 hereby affirm under penalty or perjury one.1 the following three decbrmtiaus: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-insurc for Worker's
Compensation,as provided fur by Section 3700 of the Labor Code,for the
performance of die work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95.1 the
Section 3700 of the Labor Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.E will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12.nd the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should 1 store or handle Imzardous
shall not employ any person in any manner so as to become ecoe subject to the a"terinl.Additionally,should I use equipment or devices winch emit hazardous
air contaminants ns defined by Bre Bay Are.Air Quality M...gement District 1
Worker's Compensation laws of Celifrnia.If,after making this certificate of will nalntain compliance with the Cupertino Municipal Code,Clmpter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Secfim.25505,25533,.nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/09/2018
1 certify that I have read this application and slate that the above Information Is CONSTRUCTION LENDING AGENCY
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 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 9.18. 1 understand my plans shall be used as public records.
Signature Date 08109!2018 Licensed
Professional