B-2018-0739 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0739
10216 VISTA DR CUPERTINO,CA 95014-2238(316 24 017) DEMPSTER
PLUMBING
SAN JOSE,CA 95110
OWNER'S NAME:YU ALLEN KAI-LANG AND LEE HSM-JUEI GRACE T DATE ISSUED:05/01/2018
OWNER'S PHONE: PHONE NO:(408)597-5877
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 LIc.#881509
Contractor DEMPSTER PLUMBING Date 07/31/2018 X BLDG ELECT X PLUMB
1 herebyaffirm that I am licensed under the ns of Cha ter 9 —MECH X RESIDENTIAL_COMMERCIAL
provisions p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full farce and effect. JOB DESCRIPTION:
REPLACE SEWER LINE;PROPERTY LINE CLEAN-OUT
I hereby affirm under penalty of perjury one of the following two declarations:
t. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided For by Section 3700 of the Labar 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:$25000.00
APPLICANT CERTIFICATION
I certify that pplication and shave read this atate that the above
Information Is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 316 24 017
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.
Signature Date 05-01-2018 Issued by:Kim Dunbar
Date:05/01/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law far one al'theRE-ROOFS•
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner of due property,or my employees with wages as their sale installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the structure is not intended m offered for inspection.
sae(See.7044,Business&Professions Cade)
1. 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:05-01-2018
I hereby affirm under penalty of perjury one of(Ire following three declarations: ALL ROOF COVERINGS'1'O]3E CLASS"A"OR BETTERt. I have and will maintain a Certificate of Consent toself-insure for Worker's
Compansatimr,as provided for by Section 3700 of the Labor Codc,for the
performance ofdre work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 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 Crdlfm ria Health&Safety Code,Sections 25505,25533,and 25534.twill
pemnit is issued maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,t Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject W the material.Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California.o after making this certificate of air contaminants as defined by the Bay Area At,Quality Management District I
will maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 25505,25533,a 125534.
Labor Code,I must forthwith comply with such provisions or this permit shall
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exemption,
be deemed revoked. Owner or authorized agent: _
APPLICANT CERTIFICATION Date:05-01-2018
1 certify that I have read this application and state that the above Information is C N T T.11 LENDING ACEN Y
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 ARCI II'I'EC'1"S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records,
SignatureDate 05-01-2018 Licensed
Professional