15050015CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22129 RAE LN CONTRACTOR:MIN XING PERMIT NO: 15050015
OWNER'S NAME:
PALO ALTO,CA 94301 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
ADD 499 S.F TO REAR&SIDE YARD TO ADD(1 STUDY,License Class Lic.# N)BEDROOM& 1 (1 BATHROOM.ENLARGE(E)
Contractor Date BREAKFAST NOOK,REMODEL WALL IN FOYER&
UPSTAIRS
I hereby affirm that I am licensed under 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.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate 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. Sq.Ft Floor Area: Valuation:$200000IhaveandwillmaintainWorker'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. APN Number:35607068.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is pE IT EXPIRES IF WORK IS NOT STARTEDcorrect.I agree to comply with all city and county ordinances and state laws relatingtobuildingconstruction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.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 Issued by:r' ' Date: ^ " ,
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature 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 forinspection.
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSUREconstructtheproject(Sec.7044,Business&Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
I hereby affirm under penalty of perjury one of the following three California Health&Safety Code,Sections 25505,25533,and 25534. I will
declarations: maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I have and will maintain a Certificate of Consent to self-insure for Worker's
Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardousCompensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District Iperformanceoftheworkforwhichthispermitisissued. will maintain compliance with the Cupertino Municipal Code,Chapter 912 andiIhaveandwillmaintainWorker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 2 534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance offorthwithcomplywithsuchprovisionsorthispermitshallbedeemedrevoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's AddressIcertifythatIhavereadthisapplicationandstatethattheaboveinformationis
correct.I agree to comply with all city and county ordinances and state laws relatingtobuildingconstruction,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,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional9.18.
Signature '
.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22129 RAE LN
CONTRACTOR:MIN XING P RMIT NO: 15050015OWNER'S NAME: MIN XING
265 TENNYSON ST
DATE ISSUED:07/20/2015OWNER'S PHONE:
PALO ALTO,CA 94301 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB D SCRIPTION:RESIDENTIAL
ADD 499 S.F TO REAR& SIDE YARD TO ADD(N)S TUDY,License Class Lic.#
N)BEDROOM& 1 (N)BATHROOM. ENLARGE(E)Contractor
Date BREAKFAST NOOK,REMODEL WALL IN FOYER&
I hereby affirm that I am licensed under the provisious of Chapter 9 UPSTAIRS
commencing with Sectiou 7000)of Division 3 of the Business&ProfessionsCodeandthatmylicenseisiufullforceandeffect. REVISION#1: ADD WINDOW TO GUEST ROOM.
I hereby aftirm under penalty of perjury one of the following two declarations:I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,far the
performance of the work for which this permit is issued,
I have and will maintain Worker's Compensation Insurance,as provided for by
Sq.Ft Floor Area:
Valuation:$200000
Section 3700 of the Labor Code,for the performance of the work for which thispermitisissued. APN Number:3.5607068.00 Occupancy Typr.
APPLICANT CERTIFICATTON
I certify that I have read tllis application and state that the above information iscorrect.I agree to comply with all city and county ordinances and state laws relating PE IT EXPIRES IF Wp IS NOT STARTEDtobuildingconstruction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE ORupontheabovementionedpropertyforinspectionpurposes. (We)agree to saveiindemnifyandkeepharmlesstheCityofCupertinoagainst]iabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.costs,and expenses which may accrue against said City in consequence of tllegrantingofthispermit. Additionally,tlle applicant understands and will comply Issued by;'/ L G Date: fwithallnon-point source regulations per the Cupertino Municipal Code,Section9.18.
Signature
Date RE-RO
All roofs shall be inspected prior to any ro teria]being installed.If a roof isinstalledwithoutfirstobtaininaiinsectiogIarp > g ee to remove all neI inspection. w materials forOWNR-BUILDER D CLARAT[ON
i I hereby affirm that I am exempt from the Contractor's License Law For one of Signature of Applicant: Date:the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, ALL ROOF COV RINGS TO BE CLASS"A"OR BETTERwilldothework,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code)
U I,as owner of the property,am exclusively contracting with licensed contractors toconstructtheproject(Sec.7044,Business&Professions Code).HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of theIherebyaffirmunderpenaltyofperjuryoneofthefollowingthreeCaliforniaHealth&Safety Code,Sections 25505,25533,and 25534. I willdeclarations:
maintain compliance with the Cupertiuo Municipal Code,Chapter 9.12 aud theIhaveandwillmaintainaCertificateofConsenttoself-insure for Worker's
Health&Safety.Code,Section 25532(a)should I store or handle hazardousCompensation,as provided for by Section 3700 of the Labor Code,for tl e material. Additio ally,should I use equipment or devices which emit hazlydousperformanceoftheworkforwhichthispermitisissued. air contaminants as defined by the Bay Area Air Quality Management District IwillmaintaincompliaucewiththeCupertinoMunicipalCode,Chapter 9.12 andIhaveandwillmaintainWorker's Compensation Insurance,as provided for by y Section 3700 of the Labor Code,for the performance of the work for which this
the Health&Safet Code Sections 25505,2 33,an 5534.
permit is issued. Owner or authorized agent: Z.'`I certify that in the performance of the worlc for which tl is permit is issued,I shall
Date. /;
Y
not employ any person in any manner so as to become subject to tlie Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCYbecomesubjecttotheWorker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance offorthwithcomplywithsuchprovisionsorthispermitshallbedeemedrevoked. work's for which•this permit is issued(Sec.3097,Civ C.)Lender's Name
APPLICANT CERTIFICATIONIcertifythatIhavereadthisapplicationandstatethattheabove information is Lender's Address
correct.I agree to comply with all city and county ordinances and state laws relatingtobuildingconstruction,and hereby authorize representatives of this city to enterupontheabovementionedpropertyforinspectionpurposes.(We)agree to saveindemnifyandkeepharmlesstheCityofCupertinoagainstliabilities,judgments, ARCHITECT'S DECLARATIONcosts,and expenses which may accrue against said City in consequence of the Igrantingofthispermit.Additionally,the applicant understands and will comply I tmderstand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section9.18. Licensed Professional
Signature
Date / 'Q""I
I