B-2018-0535 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0535
11066 LINDA VISTA DR CUPERTINO,CA 95014-4752(356 l6 024) OK BEE KIM
825 S SAN TOMAS
AQUINO RD 26
CAMPBELL,CA 95008
OWNER'SNAME:WONG CALVIN K AND VIVIAN DATE ISSUED:06/21/2018
OWNER'S PHONE: PHONE NO:408-440-6468
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#638489
Contractor OK HEE KIM Date 01/31/2020 X BLDG X ELECT X PLUMB
I hereby affirm that I am 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 foil force and effect. SOB DESCRIPTION:
ADDITION IN FRONT TO CREATE(N)ENTRY,LIVING ROOM,
I hereby affirm under penalty of perjury one of the following two declarations: BEDROOM AND BATHROOM;(N)NOOK AT REAR(743 S.F.);
u I have and will maintain a certificate of consent to self-insure for Worker's COVERED PORCH(86 S.F.);KITCHEN REMODEL(200 S.F.);
Compensation,as provided for by Section 3700 of the Labor Code,for the BATHROOM REMODEL(140 S.F.);INTERIOR REMODEL OF
performance of the work for which this permit is issued. MASTER BEDROOM,WALK IN CLOSET,FAMILY ROOM,
z. I have and will maintain Worker's Compensation Insurance,m provided for by LAUNDRY,DINING AND BEDROOM(1050 S.F.);(N)FURNACE-
��' Section 3700 of the Labor Code,for the performance of the work for which this ATTIC;(N)TANK-LESS WATER HEATER;RE-ROOF;TEAR OFF;
permit is issued. INSTALL COX;COMP SHINGLES(22 SQ);ELEC PANEL UPGRADE
APPLICANT CERTIFICATION (200 AMP).
I certify that I have read this application and state that the above Sq.Ft Floor Area:743 Valuation:$325000.00
Information Is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type:
inspection purposes.(We)agree to save Indemnify and keep harmless the 356 16024 R-3(Custom)
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature �, Date 6121/18 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by:Antonio Tort ex
I hereby affirm that I am exempt from the Contractor's License Lav for one of the Date:06/21/2018
following two reasons:
u I,as owner of the property,or my employees with wages as their sole
RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is
sale(See.7044,Business&Professions Code) installed without first obtaining an inspection,I agree to remove all new materials for
2. 1,as owner of the property,am exclusively contracting with licensed Inspection.
contractors to construct the project(Sce.7044,Business&Professions Cade).
1 hereby affirm tinder penalty of perjury one of the following three declarations: Signature of Applicant
t. I have and will maintain a Certificate of Consent to self-insure for Worker's Date:6/21/18
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Lubar Code,for the performance of the work for which this HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have rend the hazardous materials requirements tinder Chapter 6.95 of the
s. I certify that in the performance ofthe work for which this permit is issued,I California Health&Safety Code,Sections 25505,25533,and 25534.1 will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Worker's Compensation laws of Califoria.If,after nnakiug this certificate of Health&Safety Code,Section 25532(a)should I store or handle hazardous
exemption,I become subject to the Worker's Compensation provisions of the material.Additionally,should I use equipment or devices which emit hazardous
Labor Code,I must forthwith comply with such provisions or this permit shall air contaminants as dellned by line Bay Area Air Quality Management District I
be deemed revolted, will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
APPI,ICAN'1'CERTIFICATION �
correct.I agree to comply with all city and county ordinances and state laws Date:6/21/18
relating to building construction,and hereby authorize representatives of this City CONSTRUCTION LENDING AGENCY
to enter upon the above mentioned property for Inspection purposes. (We)agree I hereby affirm that there Is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued(Sec.3097,Civ C.)
judgments,costs,and expenses which may accrue against said City In Lender's Name
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHITEC'T'S DECLARATION
Signature Data 6121/18 1 understand my plans shall be used as public records.