B-2016-2761 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2761
10518 GASCOIGNE DR CUPERTINO,CA 95014-3842(375 23 012) TITAN GENERAL
CONSTRUCTION INC
FREMONT,CA 94539
OWNER'S NAME: LI YR IING AND LIN FANG DATE ISSUED:09/20/2016
OWNER'S PHONE:408-834-2618 PHONE NO:(408)883-8668
LICENSED CONTRACTOR' DECLARATION BUILDING PERMIT INFO:
License Class B_Lic.#948867
Contractor TITAN GENERAL CONSTRUCTION INC Date 06/30/2018 X BLDG X ELECT —PLUMB
_
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCL4,L
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: (N)TEMP POWER(100 AMP);POLE
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.
2.' 1 have and will maintain Worker's Compensation Insurance,as provided for by
j v Section 3700 of the Labor Code,for the performance of the work for which this
(ij l permit is issued. Sq.Ft Floor Area: Valuation:$500.00
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 ATN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 375 23 012
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 FROM LAST C ECTION.
Signature' = Date 09/20/2016 Issued by:MEL � ���_�'-
Date:09/20/20
OWNER-BUILDER DECLARATION
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. 1,as owner of the propert3;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 is not intended or offered for inspection.
sale(See.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:09/20/2016
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 Consentto 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,compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I 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
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 533,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:09/20/2016
certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 which 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 LendePs 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'Seusedas
DECLARATION
Code,Section 9.18. I understand my plans shall be used s public records.
Licensed
Signature Date 09/20/2016 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOKIENT DEPARTMENT• BUILDING DIVISION
0300 TORRE AVENUE• CUPER T INO, CA 95014-3255
eUPER-rIN4 (408)777-3228• FAX(408)777-3333•buildina aQcuDerino.org MISC
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DESCRIPTION OF'WOR C
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TOTAL\..LLATIONT:
By my signature below,I cerifj to each of the following: I am the prepe y owner or authorized agent to act on he prop
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application and the information I have provided is correct. I have read the TDescription of'701k and verifj,it is accurate. �'-e to comply with all applicable local
ordinances ands'?te lads relating to buil a con' coon. authorize re-presentatives of CupertLino to enter the above-identiried prope-[}l fOr inspection purposes.
Signature of;.pplicant'Rent: Date: �^ (W
SLIP LEMENTTAL INFORMATIOI T REQUIREDw.
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