B-2017-1643 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1643
1575 JAMESTO WN DR CUPERTINO,CA 95014-5312(366 10 095) TALENT DECIDE INC
LOS G
REN AND TAY SICK HUANG ET AL DATE ISSUED
OWNER'S PHON PHONE NO:(408)306-3968
LICENSED CONTRACTOR'S DECLARATION - BUILDING PERMIT INFO:
License Class B.Lie.#80895
Contractor TALENT DECIDE INC Date 06/30/2018 X BLDG_ELECT X PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 —MECH X RESIDENTIAL_COMMERCIAL
pr 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:
IST FLOOR ADDITION(t59 SF);KITCHEN REMODEL(140 SF);
I hereby affirm under penalty of perjury one of the following two declarations: CLOSETS REMODEL(90 SF);(3)BATHROOMS REMODEL(128 SF);
a. I have and will maintain a certificate of consent to self-insure for Worker's (N)2ND FLOOR BATHROOM#3(41 SF);(N)SLIDER DOOR;(N)BAY
Compensation,as provided for by Section 3700 of the Labor Code,for the WINDOW;(N)3 WINDOWS;(N)TANK-LESS WATER HEATER;RE-
pe,formance
E-
performance of the fm which this permit is issued. ROOF ENTIRE HOUSE(2,000 SF)
P/LI I have and will maintain Worker's Compensation Insurance,as provided for by RpV#1-RECONFIGURE BATHROOM-ISSUED 6-18-2018
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Vnluatton:$85000.00
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 slate laws relating to building construction,and hereby authorize 366 00 095
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 th
e v' � Date 06-18-18 Issued by:Abby Avende
Date:11/28/2017
OWNER-BUILDER DEO ARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All root's shall be inspected prior to any roofing material being installed,If a roof is
1. 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(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the pr jwt(Sce,7044,Business&Professions Code). Date:06-I8-I8
I hereby affirm under penalty of perjury one at'the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
a. I have and will maintain a Coo dficate of 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 Ibis permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and.will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements trader 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.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Coda,Section 25532(a)should I store or handle hazardous
shall not employ an reon in an manner so as to become subject m the material.Additionally,should I use equipment m'devices which emit hazardous
p y y pe y man J r contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of w'fll maintain compliance with the Cupertino Munfetpal Cade,Chapter 9.12 and
exemption,l.become-subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,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:06-18
I certify that I have read this application and state that the above information Is CON TRUCTIO LE DI CY
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 ARCBITECT'.1 DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as puhl a records.
Licensed
Signature Date 08"18-18 professional