BLD-2020-1611BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20065 CEDAR TREE LN Cupertino
APN: 316 34 003
PERMIT NO: BLD-2020-161 1
OWNER'S NAME: PANCHANATHAM SIVA AND MUTHIAH RANJANI
OWNER'S PHONE: 4082035032
JOB DESCRIPTION
FROM PG&E METER TO BBQ/FIRE PIT; INSTALL PRE-FAB BBQ ISLAND (3'X16') AND FIRE PIT; 100 LINEAL FEET (3/4") ELECTRICAL PIPE FROM
INSTALL 100 FT (1" POLYETHYLENE) GAS LINE
MAIN PANEL TO BBQ AREA; INSTALL (3) OUTLETS;
LICENSED CONTRACTOR DECLARATION
the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C27
LICENSED
EXP
02/28/2021
I hereby
force
I hereby
LANDSCAPING
DATE:
and
I have
for
I have
I certify
with
LANDSCAPE ARTISAN INC
CLASS:
NO: 1000715
affirm that I am licensed under
effect.
affirm under penatiy of perjury
and will maintain a certificate
which this permit is issued.
and will maintain Worker's Compensation
that in the performance of
laws of California. If, after
such provisions or this permit
one of the following
of consent to self -insure
Insurance,
the work for which this
making this certificate
shall be deemed revoked.
three declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
V
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
9.12 and the Health
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm is required
Certified
V
CONSTRUCTION LENDING AGENCY
that there is a construction 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
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the above
of this city
judgements,
with all non -point
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
source regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this application
construction, and hereby authorize representatives
harmless the City of Cupertino against liabilities,
the applicant understands and will comply
Signature:
II
.