B-2018-0664 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0664
10365 STERN AVE CUPERTINO,CA 95014-3643(375 10 054) FIRST
CONSTRUCTION
COMPANY
CUPERTINO,CA 95014
OWNER'S NAME;HAN XU AND WANG YIREN DATE ISSUED:1411312111
OWNER'S PHONE: PHONE NO:(408)966-2192
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.#1025763
Contractor FIRST CONSTRUCTION COMPANY Date 04/3012019 X BLDG X ELECT—PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 —MECII X RESIDENTIAL_COMMERCIAL
p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
NEW TEMP POWER POLE(100 AMP)
1 hereby affirm under penalty of perjury one of the following two declarations:
n. 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.
z I have and will maintain Worker's Compensation Insurance,u 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 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 t0 054
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 WORT{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.
Date 04-23-2018 Issued by:Kim Dunbar
Date:04/23/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt Trani 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
m. L ex owner of the property,or my employees with wages as their sole installed without fust obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work and the structure isnot intended or offered for inspection.
sale(Scc.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicanC
contractors to construct the project(Sec.7044,Business&Professions Code), Date:04-23-2018
I hereby affirm under penalty of pi one of the following three declarations: ALL 12008 COVERINGS TO BE CLASS"A"OR BETTER
n. I have and will maintain a Certificate o1'Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe 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 rend the hi—rdous materials requi,onerms under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performonee ofthe 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 die performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additiomdly,should I Lisa equipment or devices which emit hazardous
air contaminants as defined by flee 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 became subject to the Worker's Compensation provisions of the the health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:04-23-2018
I certify that I 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 ARCIIITEC'I^S UL'CLARAq'ION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 04-23-2018 Licensed
Professional