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B-2018-1113 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2018-1113 18851 BARNHARTAVE CUPERTINO,CA 95014-3601(375 16 055) CANAAN BUILDERS INC SAN JOSE,CA 95124 OWNER'S NAME:Wong Ching-ping And Lim Leycheoh Trustee DATE ISSUED:07/03/2018 OWNER'S PHONE: PRONE NO:(408)375-4288 LICENSED T BUILDING PERMIT INFO: License Class B Lic.#994043 Contractor CANAAN BUILDERS INC Date 06/30/2018 X BLDG X ELECT_PLUMB I hereby affirm that I am licensed ander the provisions of Chapter 9(commencing —MECH X RESIDENTIA _COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in fall force and effect. JOB DESCRIPTION: (N)TEMPORARY POWER POLE(100 AMP) I hereby affirm under penalty of perjury one of the following two declarations: r. I have and will maintain a certificate of consent to self-insure far Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the (Ye performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance,as In for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued, Sq.Ft Floor Arca: Valuation:$1000.00 APPLICANT CERTIFICATION I certify that 1 have read this application and slate that the above Information is correct.I agree to comply with all city and county ordinances APN Number; Occapancy'lype: and state laws relating to building construction,and hereby authorize 375 16 055 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 :,Ico r ul ions per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. al Date 07/03/2018 Issued by:Jasmine Archbold Date:07/03/2018 OWNER-BUILDER DECLARATION I hereby affirm that turn exempt from the Contractor's License Law for one of the RE-ROOFS: following hvo reasons: All roofs shall be inspected prior to any rooMg material being installed.If...['ist. 1,as owner of the property,or my employee with wages as their sole nstetied without first obtaining an nspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Scc.7044,Business&Professions Code) z I,as owner of the property,am exclusively contracting with licensed Signature ofApplicaut: contuse ors oconsrue the project Sic—c,7•044–,Ma oea& rddessi 8Codb�-Dater-- 3-2- I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 1 have and will maintain a Certificate of Consent to self-insure for Worker Compensation,as provided for by Section 3700 of the Labor Code,for the perfosmance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation hrsmance,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 California Health&Safety Code,Sections 25505,25533,and 25534.1 will permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in Bre performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or 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 bnzardous air eonhtminants 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 Municipal Code,Chapter 9.12 and exemption,l become subject to the Worker's Compensation provisions of the the Health&Sa£efy0C, , aa11 O5,25533,and 25534Labor Code,I must forthwith comply with such provisions or this permit shallbe deemed revoked, Owner or authorized - APPLICANTCERTIFICATION Date:07/03/2018 I certify that I have read this application and slate that the above information isCONSTRUCTION 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.) toenter 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 ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 07/0312018 Professional