B-2016-2415 Rev#2 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2415
20727 RODRIGUES AVE CUPERTINO,CA 95014-2964(359 10 059) JEREMY MAO INC
SARATOGA,CA 95070
OWNER'S NAME:LI XIAOCHUN AND ZHANG XIN DATE ISSUED;02/02/2017
OWNER'S PHONE: PHONL+NO:(408)449-9942
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR LIc.#813452
Contractor JEREMY MAO INC Date 10/31/2018 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:
CONSTRUCT(N)2 STORY SIT)(3,791 S.F.);ATTACHED GARAGE
I hereby affirm under penalty of perjury one of the following two declarations: (412 S.F.);PORCHES/BALCONIES/DECKS(700 S.F.)
r. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REMOVE CRAWL SPACE ACCESS AND FOUNDATION
Compensation,as provided for by Section 3700 of the Labor Code,for the VENT,REMOVE PATIO DOOR;NEW LAYOUT FOR LAUNDRY
performance of the work for which this permit is issued, ROOM;BEDROOM 2-CLOSE OFF SIDE WINDOW;BEDROOM l&2
I have and will maintain Worker°s Compensation Insurance,as provided for by -CONSTRUCT(N)WINDOW;BATHROOM#1-CHANGE TUB TO
'
permit is issued THE DECK FROM 6 TO 4-ISSUED 1-16-2018
APPLICANT CERTIFICATION - REV#2-CHANGE LANDSCAPE PLANS-ISSUED 6-21-2018
1 certify that I have read this application and state that the above Sq.Ft Floor Area:4203 Valuation:$650000.00
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 359 10 059 Deferred Submittal(R-3),R-3(Custom),R-3(Custonn),U
City of Cupertino against liabilities,judgments,costs,and expenses which (Private Gar/Ag Bldg),U(Private Gar/Ag Bldg)
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 WORI{IS NOT STARTED
Signatur?�' Date 06-21-2018 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Lav for one of the Issued by:Abby AAyende
following two reasons: I Date:02/02/2017
r. I,as owner of the property,or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for RE-ROOFS:
sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a rouf is
z. I,as owner of the properly,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for
contractors to construct the project(Sec.7044,Business&Professions Cade), inspection.
I hereby affirm under penalty of perjury one of the following three declarations:
r. I have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicant:
Compensation,as provided for by Section 3700 of the Labor Code,for the Date:06-21-2018
performance of the work for which this permit is issued.
z I have and will maintain Worker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. HAZARDOUS MATERIALS DISCLOSURE
s. I certify that in the performance of the wok for which this permit is issued,l I have read the hazardous materials requirements under Chapter 6.95 of the
shall not employ any person in any manner so as to become subject to the Colin,ria Health&Safety Cade,Sections 25505,25533,and 25534.I will
Worker's Compensation laws of California.If,after making this certificate ofm aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Section 25532(a)should I store at handle hazardous
Labor Code,I must forthwith comply with such provisions or this permit shall material.Additionally,should I use equipment or devices which craft hazardous
be deemed revoked. r contaminants as defined by the Bay Area Air Quality Management District I
will maintain complhmce with the Cupertino Municipal Code,Chapter 9.12 suit
APPLICANT CERTIFICATION the Health&Safety Cade,Sections 25505,25533,and 25534.
1 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 and state laws Owner or authorized agent: �
relating to building construction,and hereby authorize representatives of this city Data 06-21-2018
to enter upon the above mentioned property for inspection purposes. (We)agree CONSTRUCTION LENDING AGENCY
to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there Is a construction lending agency for the performance
Judgments,costs,and expenses which may accrue against said City in of work's for which this permit is issued(Sec.3097,Civ C.)
consequence of the granting of this permit.Additionally,the applicant understands Lender's Name
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. Lender's Address
Signature Date 06-21-2018 ARCHITECT'S DECLARATION
understand my plans shall be used as public rocords.
Licensed