B-2018-0909 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0909
10842 WILKINSON AVE CUPERTINO,CA 95014-4732(356 13 035) ELEMENT HOME
SOLUTIONS INC
OAKLAND,CA 94611
OWNER'S NAME:ZHOU XIA DATE ISSUED:05/29/2018
OWNER'S PHONE: PHONE NO:(888)980-4822
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lip.#997392
Contractor ELEMENT HOME SOLUTIONS INC Date 10/3112018 X BLDG_ELECT_PLUMB
I hereby affirm that I am licensed under the provfsions of Chapter 9(commencing X 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:
REPLACE AIR DUCTS SAME LOCATION(65 FT)
I hereby affirm underpenalty of perJury one of the following two declarations:
r. I have and will maintain a ccrtificatc of consent to self-inswe 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.
I have and will maintain Worker's Compensation Iusuance,as provided for by
�6 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5500,00
APPLICANT CERTIFICATION
I certify that I have read this appllcallon and state that the above
information Is correct.I agree to comply with all city and county ordinances APN Number: Occupaucy'Pype:
and stale laws relating to building construction,and hereby authorize 356 13 035
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 FAST CALLED INSPECTION.
Signature - Date 05-29-2018 Issued by:Kim Dunbar
Date:05/29/2018
OWNER-BUI, ER DECLARATION
I hereby affirm that I can exempt from the Contractor's License Law for one of rhe RE-ROOFS:
following fire reasons: All roofs shall be inspected prior to any roofing material being installed.If e of is
nst
1, I,as owner of the property,or my employees with wages as their sale installed without first obtaining on 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 exclosively contracting with licensed Signature ofApplicano
contractors to wrearuct the project(Sec.7044,Business&Professions Code). Date:05-29-2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL 1200F COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain u Certificate of Consent re 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
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requlrmnents under Chapter 6.95 tribe
Section 3700 of the Labor Code,for the performance of the work far which this California health&Safety Code,Sections 25505,25533,and 25534.1 will
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 fur which this permit is issued,I Health&Safety Code,Section 255321 should 1 store o'handle hazardous
shall not employ in an material.Additionally,should 1 use equipment or devices which emit hazardous
p y any person y manner so as[a become subject to the air contaminants as detined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California,If,after making this ccrtificatc 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 25505yj,5�33,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit doth
be deemed revoked Owner or authorized agent:..
APPLICANT CCRTI FICA'f10N Date:05-29-2018
I certify that I have read this application and state that the above information is O STRU >Nsi D 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 MunicipalARCHITECT'S DIZCLARATION
Code,Section 9.18, 1 understand my plans shall be used as public records.
Licensed
Signature Data 05-29-2018 Professional
CITY OF CUPERTINO BUILDING PERMIT
RUI LDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0909
10842 WILKINSON AVE CUPERTINO,CA 95014-4732(356 13 035) ELEMENT HOME
SOLUTIONS INC
OAKLAND,CA 94611
OWNER'S NAME:ZHOU XIA DATE ISSUED:05/29/2018
OWNER'S PHONE: PHONE ND:(888)980-4822
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#997392
Contractor ELEMENT HOME SOLUTIONS INC Date 1013112018 X BLDG ELECT_PLUMB
1 hereby allium that 1 nm licensed under the provisions of Chapter 9(commencing X 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:
REPLACE AIR DUCTS SAME LOCATLON(65 FT)
1 hereby affirm ander penalty of perjury one of the following two daelarations:
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 pemuit is issued.
1. I have and will maintain Worker's Compensation Insurance,as provided for by
�6 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.IT Floor Arun: Valuation:$5500.00
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above -
INmralion Is correct.I agree to comply with all city and county ordinances APN Number: Ocesp clay Type:
and state laws relating to building construction,and hereby authorize 356 13 035
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 05-29-2018 Issued by:Kim Dunbar
Date:05/29/2018
OWNER-Bu4bER DECLARATION
I hereby affirm that I am exempt Iron the Contractor's License Law for are of the RE-ROOI+S;
following two reasons: All roofs shall be inspected prior to any roofing material being installed,He root'is
r. I,es owner of the property,or my employee with wages as their sole installed without first obtaining an inspection,I agree to remove nil new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sals(Scc.7044,Business&Professions Cade)
z. 1,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicane
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05-29-2018
1 hereby affirm trader penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTOR
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,fm the
per of the 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 Cnlifarnin Health&Safety Code,Sections 25505,25533,and 25534.1 will
peroit is issued. in stands compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the 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 u n in an manner so as to become subject to the rarterial.Additionally,should I use equipment at-devices which emit hazardous
I y a y person y 1 air contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws ofCalifomia,If,after making this certificate of will maim in compliance with the Cupertino Municipal Cade,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505 5533,and 25534.
Labor Code,I must forthwith comply with such in or this permit shall
be deemed revoked, Owner or authorized agent:..
APPLICANT CERTIFICATION Date:05-29-2018
1 certify that I have read this application and slate that the above information is CONSTRU f f,. 1 G AGENCV
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 ARCHIT'ECT'S D i ARATI ON
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature. Date 05-29-2018 Licensed
Professional