12100079CITY OF CUPERTINO BUILDING PERMIT
BIJILDING ADDRESS: 10207 WILL CT
OWNER'S NAME: CHAI THOMAS Y AND PING C
OWNER'S NIONF,: 4082533555
❑ LICENSED CONT'RACTOR'S DECLARATION
License Class Lic. #
Contractor Date
1 hereby affirm that I am licensed tinder the provisions of Chapter 9
(commencing with Section 7000) Of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificate 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.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued.
APPLICANTCERTIFICATION
1 certify (hat 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state Imrs relating
to building construction, and hereby authorize representatives of (his 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, judgments,
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, Sectiam
9.18.
Date
❑ OWNER-RI11LDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: _
1, as owner of the property, or my employees with wages as their sole 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 R Professions Code).
hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to sell -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 bf the Labor Code, for the performance of the work for which this
permit is issued.
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.
APPLICANI' CER'T'I FICAT'ION
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 sae
indemnify and keep harmless the City of Cupenino against liabilities, judgments,
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.
Date
CONTRACI'OR: AFFORDABLE
BEATERS &
28372 CONSTELLATION RD
VALENCIA. CA 91355
PERMIT NO: 12100079
DATE ISSUED: 10/102012
PHONE NO: (661)259-7131
BUILDING PERMIT INFO: BLDG C, ELECT r PLUMB ❑
AIECII r RESIDENTIAL r CONINIERCIAL IJ
.TOB DESCRIPTION: REPLACE WATER IiFATER, SAME LOCATION
Sq. Ft Floor Area: 0 1 Valuation: $2662
APN Number: 31625025.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALI, ROOF COVERINGS'T'O BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Ileulth S Safety' Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code. Chapter 9.12 and the Ilealth & -
Safety Code, Section 25532(a) should 1 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 Dlanagement District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Ilealth & Safeh Code, Sections 25505, 25533, and 25534.
Owner Or authorized agent:
Date:
I hereby amnm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCIIITEC`I"S DECLARATION
I understmW my plans shall be used as public records.
Licensed