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B-2017-0183CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0183 10356 MENHART IN CUPERTINO, CA 95014-3631 (375 16 015) CNE CONSTRUCTION INCORPORATION SAN JOSE, CA 95130 OWNER'S NAME: XIONG WEIHUAAND MENG 2HAOHUI DATE ISSUED: 01/30/2017 OWNER'S PHONE: 408-334-1376 PHONE NO: (408) 726-2956 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a .Lic. #1 10 1892 Contractor CNE CONSTRUCTION INCORPORATION Date 03/31/2018 X BLDG X ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH 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 DESCRIPTION: (N) TEMPORARY POWER POLE (100 AMP) I hereby affirm under penalty of perjury one of the following two declarations: 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 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 Area: Valuation: $1000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 375 16 015 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 perth-dipertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. signature Date 1/30/2017 Issued by: Abby A eS nde Date: 01/30/2017 Iherebya irm 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 1. 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 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: 1/30/201 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. I will permit is issued. maintain compliance 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 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 C_W no unicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Sam, Sectio s 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. r Owner or authorized agent: APPLICANT CERTIFICATION ` Date: 1/30/2017 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 NDINGAGENCY I hereby affirm that there 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 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 1/30/2017 Si 9 Professional CUPERTINC3 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ina(cDcupertino.org 7PLumBLNG I ImpCT-TANT('dT I7LT..—II.T n - LJ+-i-1=�i��-� PROTECT ADDRESS, ( 6 } J" j f U1VL1Jl.�tLLr1NhUU5 APN 2 CM OWNERNAME �C PHONEq D9— 3) % E-MAIL A fL4e S y ! v yiafr�d� f STREET ADDRESS ° 1 CITY, STATE, ZIP FAX CONTACT NAME y t �^ O IIAAY jC PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNER EI OWNER -BUILDER ❑ OWNTERAGEATT COlv"IR.ACTOR ❑ CO, ,TTIRACTORAGENT ❑ ARCHTTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAi 4E� LICENSE NUMBER LICENSETYPE j BUS. LICi u+ COMPANY NAME E-MAIL sy`i%d2 �P��Gd i (i �n'1 FAX STREETADDRESS � Ve C01Yi Idid �l CITY, STATE, ZIP -_-- p� 7�G� v � C CA PHOi\E (a ARCHITECT/ENGINEER NAME L ENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF jWSFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN W=LAND ' ❑ YES BLIII.DAtG: ❑ CO2<CgRCLAL I URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: RECEIVED BY By lny signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owne 's beha . I have read this application and the infonnation I have provided is colTect. I have re!4e Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws selatinggto Uuildang onstruction. I authorize presenratives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: r f� `Ar Date: SFPLEMENTAL II\TFORMATI N REQUIRED OFFICE USE flr fl ©Y'ER=THE CDi77�TER 71 U STAI\DARD- 4. AZIJOR MEPMiscApp_2011.doc revised 06121/11