B-2018-0976 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0976
10455 CORTE DE SEVILLE CUPERTINO,CA 95014-3407(375 05 014) HERITAGE
CONSTRUCTION
GROUP INC
SAN JOSE,CA 95136
OWNER'S NAME:LIN KWUN-NAN TRUSTEE&ET AL DATE ISSUED:06/08/2018
OWNER'S PHONE: PHONE NO:(408)266-8303
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-17 Lic.#931230
Contractor HERITAGE CONSTRUCTION GROUP INC Date 04/30/2019 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 full force and effect. JOB DESCRIPTION:
WINDOW REPLACEMENT(6);LIKE FOR LIKE TO MEET EGRESS
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 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
perfermanec 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:54400.00
APPLICANT CF.R11EICATION
I certify that I have read this application and state that the above ane APN Number: Occupancy information Is correct.I agree to comply with all city and.county ordinances p y Type:
and state laws relating to building construction,and hereby authorize 375 05 014
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 6'Cupe !no Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06108/2018 Issued by:Kim Dunbar
Date:-06/08/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
]'allowing two reasons: Ail roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,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(Sce.7044,Business&Professions Code)
z I,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicane
contractors to construct the project(Sec.7044,Business&Professions Code), Date:06/08/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 1 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
z. 1 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&SafetyCade,Sections 25505,25533,and 25534.twill
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 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 tine an taterim.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 ofCalifomia.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 tell a 5505,25533,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:06/0812018
I certify that I have read this application and state that the above Information is CONSTRUCTIO LE DI G A
correct.I agree to comply with all city and county ordinances and slate 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 properly 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 Munlclpai 6RCIi1TECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 06/08/2018 Licensed
Professional