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B-2016-2725 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2725 20607 PARADISE DR CUPERTINO,CA 95014-2915(359 15 011) BAY AREA TRENCHLESS MORGAN HILL,CA 95037 OWNER'S NAME: TAN KENNETH C DATE ISSUED:09/14/2016 OWNER'S PHONE:408-892-8702 PHONE NO:(408)981-5730 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC-36 Lic.#631706 X BLDG _ELECT X PLUMB Contractor BAY AREA TRENCHLESS Date 02/28/2017 — I hereby affirm.that I am licensed under the provisions of Chapter 9(commencingMECH X RESIDENTIAL COMMERCIAL. — — with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCION' REPLACE 'i� '& I hereby affirm under penalty of perjury'one of the following two declarations: LINE CLE e 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. i i r I have and will maintain Worker's Compensation Insurance,as provided for by �}r�`• Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500.00 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 359 15 011 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 of this permit. WITHIN.180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS CTION. Signature--- Date 09/14/2016 Issued by: LISSAN S ` Date:09/14/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is i. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure isnot intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/14/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous s. 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 material. Additionally,should I use equipment or devices which emit hazardous air contaminants 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 compliance with the Cupertino Municipal Code,Chapter 9.12 and -exemption,I become subject to the Worker's Compensation provisions of the, the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:, � APMCANT CERTIFICATION Date:09/14/2016 I certify that I have read this application and state that the above information is I hereby affirm that there is a construction le ' agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant,understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 09/14/2016 professional GENERAL PERMIT APPLICATION MEF COArWiUNI TY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPER T INO, CA 95014-3255 F curl=RT[NO. (408)777-3228 • FAX(408)777-3333 build!na(E>cuoertino.ora 4f3- Z016 2-7- P Z - LLTBII�G ❑h/iECIiA1\7CAL ❑ELECTRICA-L ❑1✓ISCELLANT-EOUS PROSECT ADDP.ESS Q I .APN E 3r / O\AN-ERN Ahs � PHONE STRrET-JDRESS2 CITY, ST/7TE.ZIP 't TAX �L� ly CO\iACT N-niE F,,ATL a A STREETA7DPES5 CITY STATE ZIP CM-N-M ❑ OWNE -BUILDER ❑ o7,?,7=RAGz rr �(COKMICTOR ❑C01\i?4CTORAGB1,T ❑ .A.PCHITECT ❑-KGIl�•wR ❑ DE\LLp;°'R ❑ rE?�.i?�-T CO T R4CTOP.N k1'E LICENSE NIII,SER LIC SE i1T Bus.LIC" pzecc_ 1 nctes� I 6 - C 3 13 9 2-- COIuPaNYMIXE rr E-?J,4IyL,rr�� X 77 // F .�LG4I STREET ADDP=S570 Cp) CITY,SPATE,ZIP 7 PHONE ,RC±DTECT;EtiGLNEERN::\iE i ?ICENSE>`RBIBER BUS.LIC' COMPAW3*4-_111E E-!,,LkIL Fs� STREET ADDRESS I CITY,STATE,ZIP I PHO\E LSE OF ❑SFD orDLTPLE7. ❑ 1,XLTi-FAMULY PROJECT I]N IVILDLAAM. ❑ YES PROJECT IN. ❑77ES - f is THE BLDIG.A-V ❑vs BUILDING: ❑COA\u'RCIAL U BAN SA.`TERFACL-AREA ❑ NO FLOOD ZONE ❑\'O E?Ch'LERHONE? ❑NO DESCRIPTION OF FORK j � �Qc`hoc� TOT t V:LL-TION: By my signature below.I cerci ,to each of the follova ing: I am Lhe property-owneray authorized agent to act on the property owner's behalf, I have read this application and the information I have provided is correct. I have read Lhe Description of Work and ve-i-R,it is accurate. I agree to comply with all applicable local ord_nauces and state laws r elating to b ,a g C0n57Lction. I authorize representatives of Cupertino to enter the above-identiil property for inspection pm-poses. Signature ofAoplicant%Agent: Date: SUPPLENIEAIT. ORbiATIO.N REQUIRED 'OFFICE L',SE R rnE COLIT�R ❑ E_�,PRE�S� n 1-1 ST - _RD, a Z ❑ �RGE J24JOR fi ?i EP?i%isc,,v_p_201].doe revised 06121111