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B-2017-1684 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1684 858 CANDLEWOOD DR CUPERTINO,CA 95014-4653(369 19 027) ROOTER HERO PLUMBING INC MISSION HILLS,CA 91346 OWNER'S NAME: AN DONG AND KANG LI DATE ISSUED:09/28/2017 OWNER'S PHONE: PHONE NO:(888)929-4376 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#973014 Contractor ROOTER HERO PLUMBING INC Date 05/31/2018 YX BLDG _ELECT XC 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: INSTALL PROPERTY LINE CLEAN OUT 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 erformance of the work for which this permit is issued. 7a have and will maintain Worker's Compensation Insurance,as provided for by ' 4F a Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4445.00 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 369 19 027 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 e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ` ......--- Date 9/28/2017 Issued by:AY Ayende ende Y 1, Date:09/28/2017 i ' 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. I,as owner of the property, their so or my employees with wages as le installed without first obtaining an inspection,I agree to remove all new materials for , inspection. compensation,wing the,work,and the structure is not intended or offered for ' 1 , sale(Sec.7044,Business,&Professions Code) ' 2. I,as owrier of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/28/2017 I hereby affirm under'penalty of'perjtry one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"9"OR BETTER i. I have and will mainta'in'a'Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the , perfor nance'of the work:for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have,arid 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 i'::,. ued.' 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 Compensation laws of California. If,after making this certificate of will maintain compliance with the Cup'- n r Municipal Code,Chapter 9.12 and exemptioln,I become subject to the Worker's Compensation provisions of the the Health&Safety Code :ectio :25505,25533,a,,' 25534. Labor Code,.I must•forthwith comply with such provisions or this permit shall ``r be deemed revoked. • - or authorized agent: �' APPLICANT CERTIFICATION I ate:9/28/2017 I certify that I have read this application and state that the above information is CONSTRU TION 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 ' i consequence of the granting of this permit. Additionally,the applicant understands and will comply with,allinon-point source regulations per the Cupertino Municipal ARCHITEC 'S DECLARATION Code,Section 9:18.; , l I understand my plans shall be used as public records. Signature Date 9/28/2017 Licensed Professional