BLD-2020-1151BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 4181 FIRST ST.
APN: 359 16 031
PERMIT NO: BLD-2020-1 151
CONTRACTOR:
NORCAL CONSTRUCTION & DEVELOPMENT INC, 4181 FIRST ST LIVERMORE
CONTRACTOR PHONE:
19254497774
DATE ISSUED 7/30/2020 1:19:03 PM
ISSUED BY: JASMINEARCHBOLD
VALUATION: $10000
JOB DESCRIPTION
INSULATION (32 SF); FLOORING (250 SF); NEW FULL HEIGHT CABINET (8 LF)
KITCHEN WATER DAMAGE REPAIR - REPLACE DRYWAL AND
LICENSED CONTRACTOR DECLARATION
Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
NORCAL
LICENSED
B GENERAL
LICENSED
923401
EXP
10/31/2020
I hereby
force
I hereby
CONSTRUCTION & DEVELOPMENT INC
CLASS:
BUILDING CONTRACTOR
NO:
DATE:
affirm that I am licensed under the provisions of
and effect.
affirm under penatiy of perjury one of the following
I have and will maintain a certificate of consent to
for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,
I certify that in the performance of the work for which
laws of California. If, after making this certificate
with such provisions or this permit shall be deemed
three declarations:
self -insure for Worker's
as provided
this permit is issued,
of exemption,
revoked.
Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I shall not employ any person in any manner so as to become subject to the Worker's
I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under Chapter 6.95
Health & Safety
as defined
Code, Sections 25505,
of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code. Chapter 9.12 and the
V
with
equipment
Municipal
Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
EPA LEAD -SAFE DISCLOSURE
for this project.
Firm Certification No:
project.
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name: MICHAEL HARVEY
No EPA Lead -Safe Certified Firm is required for this
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
the above information
city to enter
costs,
source
upon
and expenses
regulations
is correct. I agree to comply with all city and county ordinances and state laws relating to building
the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
which may accrue against said City in consequence of the granting of this permit. Additionally,
per the Cupertino Municipal Code. Section 9.18.
I certify that
construction,
harmless
the applicant
Signature:
I
the
have read this application and state that
and hereby authorize representatives of this
City of Cupertino against liabilities, judgements,
understands and will comply with all non -point
days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.