BLD-2021-0783BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 19132 COZETTE LN Cupertino
APN: 375 07 024
PERMIT NO: BLD-2021-0783
OWNER'S
CONTRACTOR: PLATEAU BUILDING GROUP INC, 523 IRVING AVE SAN JOSE
CONTRACTOR PHONE:
DATE ISSUED 7/13/2021 7:02:00 PM
ISSUED BY: haleym
VALUATION: $13500
JOB DESCRIPTION
REPLACE (E) WINDOWS (10)
REMODEL BATHROOMS (120SF);
LICENSED CONTRACTOR DECLARATION
of
following
to
Insurance,
which
certificate
Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
B GENERAL
LICENSED
EXP
05/31/2022
I hereby
force
I hereby
PLATEAU BUILDING GROUP INC
CLASS:
BUILDING
NO: 915940
DATE:
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work for
laws of California. If, after making this
with such provisions or this permit shall be deemed
three
self -insure
this
revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
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
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under
and the Health
Code,
Chapter 6.95 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
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
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Building Group
Firm Certification No: NAT-F190339-1
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name: Plateau
No EPA Lead -Safe Certified
V
Certified
CONSTRUCTION LENDING AGENCY
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 that there is
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state
representatives
against liabilities, judgements,
will comply with all
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 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.