BLD-2019-1319BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 19399 CALLE DE BARCELONA Cupertino
APN: 375 04 012
PERMIT NO: BLD-2019-1319
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 11 /6/2019 2:05:31 PM
ISSUED BY: JARCHBOLD
VALUATION: $3200
JOB DESCRIPTION
UPGRADE MAIN PANEL SAME LOCATION - (200 AMP)
OWNER -BUILDER DECLARATION
I hereby
affirm under penatly of perjury one of the following two
declarations:
I, as owner of the property, or my employees with wages as their role compensation, will do the work, and the structure
is not intended or offered for sale (Sec. 7044. Business
& Professions
Code).
I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business & Professions Code).
V
I hereby
affirm under penatiy of perjury one of the following two
declarations:
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.
V
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
Compensation
laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
comply with such provisions or this permit shall be deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under
Chapter 6.95 of the California Health & Safety Code, Sections 25505. 25533, and 25534. I will maintain compliance
V
with
the Cupertino Municipal Code, Chapter 9.12 and the Health
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
equipment
or devices which emit hazardous air contaminants
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Municipal
Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534.
An EPA Lead -Safe Certified Renovator will be responsible for this project.
Certified
Firm Name:
Firm Certification No:
v
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
I hereby
affirm
under penalty of perjury that there is a construction
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Yes
V
No
Lender's
Name:
Lender's Address:
APPLICATION 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 and state laws relating to building
construction, and hereby authorize 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, judgements, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
the applicant understands and will comply with all non -point source
regulations per the Cupertino Municipal Code, Section 9.18.
Signature:
....061/do
.