BLD-2021-15808/18/2021
CITY OF CUPERTINO BUILDING PERMIT
BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10894 DRYDEN AVE Cupertino 1 APN:356 15 017
PERMIT NO: BLD-2021-1580
OWNER'S NAME: AMARNATH K R AND ANITA
3
OWNER'S PHONE: Not Provided
_
CONTRACTOR: MC WINDOWS AND DOORS DBA MC WINDOWS AND GLASS DOORS, 1678 HIGHLAND CIRCLE FAIRFIELD
CONTRACTOR PHONE:
DATE ISSUED 8/18/2021 2:27:01 PM
ISSUED BY: phuongd
VALUATION: $8178
JOB DESCRIPTION
REPLACE WINDOWS- BEDROOMS 1 &2 TO MEET EGRESS, REPLACE WINDOWS (4) LIKE FOR LIKE; REPLACE SLIDERS (2) LIKE FOR LIKE
LICENSED CONTRACTOR DECLARATION
CONTRACTOR: MC WINDOWS AND DOORS DBA MC LICENSED
WINDOWS AND GLASS DOORS C 17
I hereby affirm that I am licensed under the provisions
CLASS:
GLAZI
of
Chapter
NG
9
LICENSED NO: 1022017 EXP
12/31/2022
(commencing with Section 7000) of Division 3 of the Business & Professions
DATE:
Code
and that my license is in full force
and effect.
I hereby affirm under penalty of perjury one of the following three declarations:
have and will maintain a certificate of consent to self -insure for Worker's Compensation, for by Section
as provided 3700 of the Labor Code, for the performance of the work for
which
this permit is issued.
,A
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.
certify that in the performance of the work for which this is issued, I in
permit shall not employ anyperson
anymanner so as to become Worker's Y co e subject to the 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
CII
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 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 devices
I
or
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.
EPA LEAD -SAFE DISCLOSURE � V
An EPA Lead -Safe Certified Renovator will be responsible for this
'
Certified
project.
r - r
i
Firm Name:: 1 Firm Certification No:1 ,
L J L
NI
No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
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
j-
No
r r n
Lender's Name: i 1 Lender's Address: i ;
L J L J
APPLICATION CERTIFICATION
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
i 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 appicant
understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature:
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.
Submit
https://apps.cupertino.org/Accela/BLD-Sign-Permit.aspx?AccelaUser=ONETIMESIGN&OTK=601uCX1IsBkfB2HrcUnskcEfSS8F9jn7ozApSMyWMdni5... 1/1