B-2018-1116 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1116
20303 CLIFDEN WAY CUPERTINO,CA 95014-4404(369 35 040) Kim Michelle Mee
Yhung
20303 Cli£den Way
Cupertino,CA 95014-
4404
OWNER'S NAME:Kim Michelle Mee Yhung DATE ISSUED:07/03/2018
OWNER'S PHONE: PHONE NO:408-621-2923
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class LIc.#
Contractor Kim Michelle Mee Yhung Date 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 Divislon 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMODEL BATH(50 SF);REPLACE(1)WINDOW WITH A DOOR:
I hereby affirm under penalty of perjury one of the following two declarations: AND REPLACE(1)DOOR WITH A WINDOW
r. 1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Flom-Area: Valuation:$20000.00
I APPLICANT CERTIFICATION
certify that 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 369 35 040
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 07/03/2018 Issued by:Jasmine Archbold
Date:07/03/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
f Il g two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
j 1,as owner of Ore property,o my employee with wages as their sole installed without first obtaining all inspection,I agree to remove all new,materials Por
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicanc
contractors to construct the project(Sce.7044,Business&Professions Code), Date:07/03/2018
I her y affirm under penalty of perjury one of the following three rectorial a s: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
ei.r 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z, 1 have and will maintain Worker's Compensation Insurance,as provided far by I have react the hazel dolls 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.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,i IIselth&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ n in an manner so as to become subject to the matarts[.Additionally,should 1 use equipment or devices which emit hazardous
p y any person y J air contaminants as dented by the Bay Area Ali 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,I 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 / � -
APPLICANT CERTIFICATION Date:07/03/201 B
1 certify that I have read this application and state that the above information is CONSTRUCTION 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-point source regulations per the Cupertino Municipal ARCH PI'EC'I^5 DECLARATION
Code,Section 9.18.., �/ /> 1 understand my plans shall be used as public records.
Signature' Date 0 710 312 0 1 8 Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1116
20303 CLIFDEN WAY CUPERTINO,CA 95014-4404(369 35 040) Kim Michelle Mee
Yhung
20303 Clifden Way
Cupertino,CA 95014-
4404
OWNER'S NAME: Kim Michelle Mee Yhung DATE ISSUED:07/03/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Kim Michelle Mee Yhuno Date 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:
REMODEL BATH(50 SF);REPLACE(1)WINDOW WITH A DOOR:
I hereby affirm under penalty of perjury one of the following two declarations: AND REPLACE(1)DOOR WITH A WINDOW
t. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-STRUCTURAL FOR REMOVAL OF LOAD BEARING WALL-
Compensation,as provided for by Section 3700 of the Labor Code,for the ADD SUPPORT BEAMS AND POSTS;REVISE BATHROOM LAYOUT;
performance of the work for which this permit is issued. REVISE DOOR TYPE AT LIVING ROOM TO CANTINA TYPE.
2. I have and will maintain Worker's Compensation Insurance,as provided for by ISSUED 9.13.18
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$20000.00
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 state laws relating to building construction,and hereby authorize 369 35 040
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 this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all ll non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 09/13/18 Issued by:Jasmine Archbold
Date:07/03/2018
OWNER-BUILDER D . ARAUON
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
t. I,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 project(Sec.7044,Business&Professions Code). Date:09/13/18
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this 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 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. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
t� 3. I certify that m the performance of the work for which this permit is issued,I Health&Safety Code,Section 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 ussee equipment
ment or devices which emit hazardous
air contaminants 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,I 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:09/13/18
1 certify that I have read this application and state that the above information is CONSTRUCTION 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-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
to 09/13/18 Licensed