B-2017-0553CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0553
10857 BARRANCA DR CUPERTINO, CA 95014 (326 01 013)
TANG'S BROTHERS
CONSTRUCTION INC
LOS GATOS, CA 95033
OWNER'S NAME: CHEM YU-HSIANG AND CARTEL VERONICA
DATE ISSUED: 04/07/2017
OWNER'S PHONE:
PHONE NO: (408) 528-5430
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B C10 Lie. #954903
Contractor TAN BROTHERBROTHEE59 QONSTRITION INCDate 11/30/2018
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:
I hereby affirm under penalty of perjury one of the following two declarations:
INSTALL TEMPORARY POWER POLE (100 AMP)
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.
2. /-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: $500.00
APPLICANT
RTIFI ATION
1 certify that I have read this application and state that the above
"N Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
326 01 013
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
may accrue
PERMIT EXPIRES IF WORK IS NOT STARTED
against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CAL INSPECTION.
jthe
Signature .
i nature,/ Date 04/07/2017
Issued by: MEL
OWNER-B ILD R D C'I A ATION
Date: 04/07/2017
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
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: 04/07/2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
OSt RE
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
s. 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
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
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:,'
APPLICANT CERTIFICATION
Date: 04/07/2017 -
I certify that I have read this application and state that the above information is
NONLE"GAGENCY
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 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
ARATION
ARCHITECT'S DECLARATION
Code, Section 9.18. 1
understand my plans shall be used as public records.
Licensed
Signature Date 04/07/2017 Professional