B-2018-0491 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0491
7538 KINGSBURY PL CUPERTINO,CA 95014-5045(362 30 024) Soochan Chung
41498 Timber Creek
Terrace FREMONT,CA
94539
OWNER'S NAME: DATE ISSUED:06/12/2018
OWNER'S PHONE: PHONE NO:(510)709-8356
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#856215
Contractor Soochan Chuna Date 03/31/2019 X BLDG X ELECT X PLUMB
I hereby affirm that I mn licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)ofDivlsion 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
ONE STORY ADDITION(297 SY.);REMODEL(2)BATHROOMS(160
I hereby affirm under penalty of perjury one of the following two declarations: S.F.);KITCHEN REMODEL(115 S.F.);OTHER REMODEL(565 S.F.);
1. 1 have and will maintain a certificate of consent to self-insure for Worker's REPLACE(5)WINDOWS AND(3)DOORS;REPLACE AND
Compensation,as provided for by Section 3700 of the Labor Code,for the RELOCATE FURNACE,WATER HEATER AND AC;UPGRADE
perfma
ornce of the work for which this permit is issued. ELECTRICAL PANEL(200 AMP).
2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Cade,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:297 Valuation:$100000.00
APPLICANT CERTIRICATION'
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 362 30 024 R-3(Custom)
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 06-12-2018 Issued by:Kim Dunbar
Date:06/12/2018
OWNER-RUILDER 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
1. I,as owner.1 the property,or any employees with wages as their sole installed without first obtaining an inspection,I agree to remove all uew materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sm.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Data:06-1.2-2018
I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 have and will maintain a Certificate of Consent to self-insure£or 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 1 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 Cade,Sections 25505,25533,and 25534,1 will
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in die performance of the work for which this permit is issned,I Health&Safety Code,Section 25532(.)should I aloe an 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
ontaminants as defined by the 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 Municipsd Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cade,Sections 25505,25533,and 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:06-12-2018
1 certify that I have read this application and state that the above Information is CQNSTRUCTION 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-polnl source regulations per the Cupertino MunicipalARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 06-12-2018
Professional