B-2017-1389 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1389
19772 WHEATON DR CUPERTINO,CA 95014-2458(316 28 002) OK HER KIM
CAMPBELL,CA 95008
OWNER'S NAME:NAIKSATAM SUMIT AND DAHAKE JUEELI G DATE ISSUED:08123/2017
OWNER'S PHONE:408-202-3437 PHONE NO;(510)557.4176
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.#1x3$4.@9
Contractor OK BEE KIM Date 01/31/2018 X BLDG_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 fall force and effect. JOB DESCRIPTION:
INTERIOR REMODEL(REMOVE ALL SHEETROCK THROUGHOUT)
I hereby affirm tinder penalty of perjury one of the following two declarations: (1335 SQ FT);REPLACE(7)WINDOWS AND(1)DOOR;INSTALL
m. 1 have and will maintain a certificate ofemsent to self-insure for Worker's FIRE SPRINKLERS THROUGHOUT RESIDENCE.
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfermance of the work for which this permit is issued. REV#I:CONSTRUCT(N)FRONT COVERED PORCH(120 SF)-
r�z. I have and will maintain Worker's Compensation Insurance,as provided for by ISSUED 01-25-2018
Seetion 3700 of the Labor Code,for the performance of the work for which this
permit is issued. **NOTE: SQ FT DOES NOT INCLUDE AREA UNDER PERMIT B-
APPLICANT CERTIFICATION 2017-0809.**
1 certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$45000.00
information Is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize
representatives of this cityto enter upon the above mentioned property for APN Number: Occupancy Type.
inspection purposes. (We)agree to save indemnify and keep harmless the 316 28 002
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature�� ------) Date 01-25-2018 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by:Jasmine Archbold
I hereby affirm that I am exempt from the Contractor's License Law for one of the Date:08/23/2017
following two reasons:
a. I,as owner ofthe property,or my employees with wages as their sole RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for A0 roofs shall be inspected prior to any roofing material being installed,If a roof is
sale(Sce.7044,Business&Professions Code) installed without first obtaining an inspection,I agree to remove all new materials for
z. I,as owner of the property,am exclusively contracting with licensed inspection.
contractors to construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
a. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Date:01-25-2018
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. ALL ROOF COVERINGS TO 1313 CLASS"A"OR BETTER
z. I have and will maintain Worker's Compensation losurance,as provided for by
Section 3700 of the Labor Cade,for the performance ol'the work for which this HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous matmiais requirements under Chapter 6.95 of the
a. I certify that in the performance ofthe work for which this permit is issued,I California IleaRl,&Safety Code,Sections 25505,25533,and 25534.1 will
shall not employ any person in any manner so as to beconac subject to the maintain compiler.with the Cupertino Municipal Code,Chapter 9.12 dad the
Worker's Compensation Iowa of California,If,after making this certificate of Health&Safety Code,Section 25532(x)should I store or handle hazardous
exemption,I become subject to the Worker's Compensation provisions of the material.Additionally,should I use equipment or devices which emit hazardous
Union Code,[,,,.at forthwith comply with such provisions or this permit shall air timmininants es defined by the Bay Area Air Quality Management District l
be deemed revoked. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25VQ5,25533,and 25534.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Information Is owner or authorized agent: v �'
correct.I agree to comply with all city and county ordinances and state
Iaws Date:01-25-2018
relating to building construction,and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY
to enter upon the above mentioned property for Inspection purposes. (We)agree I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is Issued(Sec.3097,Civ C.)
judgments,costs,and expenses which may accrue against said City In Lender's Name
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHITECT'S DECLARATION
Signature Date 01-25-2018 1 understand my plans shall be used as public records.
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1389
19772 WHEATON DR CUPERTINO, CA 95014-2458 (316 28 002)
OK HEE KIM
CAMPBELL, CA 95008
OWNER'S NAME: NAIKSATAM SUMIT AND DAHAKE JUEELI G
DATE ISSUED: 08/23/2017
OWNER'S PHONE: 408-202-3437
PHONE NO: (510) 557-4176
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. #638482
Contractor OK HEE'KIM Date 01/31/2018
X BLDG —ELECT —PLUMB
—
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
—_
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
INTERIOR REMODEL (REMOVE ALL SHEETROCK THROUGHOUT)
I hereby affirm under penalty of perjury one of the following two declarations:
(1335 SQ FT); REPLACE (7) WINDOWS AND (1) DOOR; INSTALL
1.. I have and will maintain a certificate of consent to self -insure for Worker's
FIRE SPRINKLERS THROUGHOUT RESIDENCE.
mpensation, as provided for by Section 3700 of the Labor Code, for the
of the work for which this permit is issued.
**NOTE: SQ FT DOES NOT INCLUDE AREA UNDER PERMIT B -
WWrformance
I have and will maintain Worker's Compensation Insurance, as provided for by
2017-0809.**
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $45000.00
permit is issued.
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
316 28 002
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 CALLED INSPECTION.
/ v
e G/���i'LJ Date 8/23/2017
Issued by: Jasmine Archbold
O
Date: 08/23/2017
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
t. 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)
z. 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: 8/23/2017
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. 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 25505,255M, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
O .,;e ..n rized agent:
APPLICANT CERTIFICATION
k
I certify that 1 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
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.
Signature Date 8/23/2017
Licensed
Professional