B-2019-0694 CITY OF CUPLK111r Lvyyi
OR:
PERMIT NO:B 20190694
CONT�CTRUCTION
CNE CONS
G ADDRESS: 4-4547(369 27 035) INCORPORATIO
3UILDIN CA 9501 SAN JOSE,CA 95130
338 BETLIN AVE CUPERTINO> DATE ISSUED:04/23/2019
OWN ER'S N AME
AND SU PHONE NO:(408)726-
BUILDING PERMIT INFO'
LICENSED CBLDG X ELECT _PLUMB
LIC ON X B RESIDENTIAL
_COMMERCIAL
ic.#1012 _MECH X
License
Class B RPORATION Date 0313112020
CNE CONSTRUCTION INC f Chapter 9(commencing
Contractorprovisions o
I hereby affirm that I am licensed under the p &Professions Code and that my JOB DESCRIPTION'. 0 AMP)
00 of Division 3 of the Business TEMP POWER POLE(1
with Section 70 d effect.
license is in full force antwo declarations.
alt of perjury one of the following -insure for Worker's
1 hereby affirm under pen Y
taro a certificate of consent to sel bot Code,for the
1. I have and will main Provided for by Section 3700 of the La
Compensation,as pT0 perm,Ion
is issued.
provided for by
performance of the work for which thismpensation Insurance,asp this 0.00
2. have and will maintain Workers
for the p
permit is issued.
Occupancy ape:
A
PPLICANT CERTIFICATIOlN above APN Number:
d this application and state that d county ordinances 369 27 035
1 certify that I have tea agree to comply with all city authorize
'information is correct.I a9 construction,and hereby prope
for NOT STARTED
info to building -WORK IS
and state laws relating ter upon the above mentioned parmless the EXpjRES IF OR
a to en PERMIT
representatives of this city save indemnify and keep s which PERMIT ISSUANCE
repres purposes.,
(We)agree to N 1S0 DAYS OF
ection purp •udgments,costs,and expen�his ermit wITHI -D INSPECTION
city against liabilities,) ranting of p -LAST CALLS
Cupertino ag in consequence non-point
FROM
City of Cup t said City uence of o granting all non-p 80 DAYS
may accrue against 1
licant understands and will.c comply
9.18.
Additionally,the app per the Cupertino Municipal Code,
source regulations p ,Kiln Dunbar
Issued by:
Date 4-23-2019 Date:04/23/2019
Signature RE_ROOFS:
r in material bung installed.If roof
"✓DECLARATION rior to any roofing
r one of the fs shall be inspected p n I agree to remove all new materials
OWNER-BUILJ2E All roo an inspectio
the Contractor's License La�'�'for ed without first obtaining inspection.
affirm that I am exempt from install
1 hereby es as their sole
following two reasons: ert or my employees with wag
1. I,as
owner of the prop y' structure is not intended or offered for
compensation,
will do the work,and the Code) Signature of Applicant.
ale Sec.7044,Business&Professions Date:4-23-2019
s ( am exclusively contracting with licensed
Code). BETTER
z. I,as owner of the property, project(Sec.7044,Business&Profess CLASS"A"OR
contractors
to construct the p J ALL ROOF COVERINGS TO BE
penalty of perjury
one of the following three declar�orker's DISCLOSURE b affirm under p ertificate of Consent to self-insure fo for the HAZARDOUS MATERIALS DISCLOS Chapter 6.95 of
I
hereby HAZ
have and will maintain a C uirements and 25534. I��
r b Section 3700 of the Labor Code, a hazardous materials req OS 25533,
Compensation,as provided for y I have read the Sections 255 ,
work for which this permit is issued. rovided for byCode, Chapter 9'12 an
e w surance,asp California Health&Safety Municipal Code, le hazard
performance of the ensation In Bance with the Cupertino
maintain Worker's Comp of the work for which this maintain comp ion 25532(a)should I store or handle
emit hazy
2, I have and will for the performance Code,Sect
the Labor Code, Health&Safety should I use equipment or devices wmitDia
Section 3700 of ualit Management
ich this permit is issued,I material. Additionally,sh the Bay Area Air Quality
vCode,Chapter 9.
permit is issued• sub ect to the
performance of the work for which e air contaminants as defined Y and 25534.
the become J 'ance with the Cupertino municipal
3. I certify that in p erson in any manner so as to be Sections 25505,2
an kin this certificate of will maintain compliance Safety Code,
shall not employ Y p the Heal
Worker's Compen
sation laws of California• If,after ma logprovision
s of the ..
exemption,I beco
me subject to the Worker's Compensatns of this permit shall age
must forthwith comply with such provisio owner or authorize
Labor Code,I m Date:4-23-2019 for the perfc
CONSTRUCTION LENDING AGENCY
be deemed revoked. CONS agency IFICATION is that there is a construction lending a Civ C.)
APPLICANT CERT I hereby affirm Sec.3
and state that the above inform laws � for which this permit is issued
application ordinances and state of work's
I certify that I have read thW' pall city and county resentatives of this city Lender's Name
correct.i agree to comply authorize rep We agree
and hereby for inspection purposes. ( )
relating to building construction, erty
the above mentioned Prop it of Cupertino against liabilities, Lender's Address
to enter upon keep harmless the C y against said City in
and rue ARCHITECT'S DECLARAT d
to save indemnify and expenses which may acct Tonally,the applicant understandsublic recor
judgments,costs, permit. Addition Cupertino Municipal derstand my plans shall be used as p
�udg ranting of thisp pe the Cupe I un
consequence of the all non-point source regulations p
and will comply W$
Code,Section Licensed
Date 4-23-2019
Professional
ature