B-2016-2375 CITY OF CUPERTINO BUILDING,PERMIT
BUIL.DINGADDRESS: CONTRACTOR,: PERMIT NO:B-2016-2375,
10390 OAKVILLE AVE CUPERTINO,CA 950144573(369 13 013) VOLTZ ELECTRIC
SAN JOSE,CA 95123
OWNER'S NAME: LEE WING CHEUNG AND NI JUN DATE ISSUED:07/25/2016
OWNER'S PHONE:408-8814084 PHONE NO:(408)464-8588
LICENSED CONTR TOR'S DECLARATION BUILDING P RMIT INFO:
License Class C-10 Lie.#912372
Contractor VOLTZ ELECTRIC Date 07/31/2018 X_BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing _MECHXRESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two.declarations: UPGRADE PL(200 AMP);SAME LOCATION
i. I have and will maintain a certificate of consent to self-insure for Worker's
p p Compensation,as provided for by Section 3700 of the Labor Code,for the
J �performance of the work for which this permit is issued.
ljz' 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. Sq.Ft Floor Are : Valuation:$4500.00
APPLICANT 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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 13 013
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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting.. this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all ll non-point
source regulations p the Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
f�
/,SignatureDate 7/25/2016 Issued by:Abby A ende
CJ Date:07/25/20 6
R-B DE DE L TIO
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS:
following two reasons: All roofs shall b inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their soleinstalled without I irst obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/25/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
permit is issued. maintain compti ince with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material Additi nally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminant as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain co apliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the He Ith&Safety Code,Sec'ons 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. (Owner or authorized agent:
APPLICANT CERTIFICATION Date:7/25/2016
1 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 I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for whi h this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 7/25/2016 Professional