B-2018-1104 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1104
7409 PROSPECT RD CUPERTINO,CA 95014-5241(366 15 044) A PLUS GENERAL
CONTRACTORS INC
GARDEN GROVE,CA
92841
OWNER'S NAME:Liu Changming And Wei Aimei DATE ISSUED:06/29/2018
OWNER'S PHONE: PRONE NO:(714)901-0500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lie.#763154
Contractor PLUS GENERAL CONTRACTORS INC Date 05/31/2019 X BLDG_ELECT_PLUMB
1 herebyaffirm that 1 am licensed sunder the f Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
provisions o p ( g
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full farce and effect. JOB DESCRIPTION:
INSTALL(N)AC UNIT-SIDE YARD
I hereby affirm under penalty of perjury one of the following two declarations:
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,rot the
performance of the work for which this permit is issued.
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 Floor Arca: Valuation:$6000.00
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 366 15 044
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 nderstands and will comply with all non-point
source regulations perch ertlno Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 06/29/2018 Issued by:Jasmine Archbold
Date:06/29/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt Trani the Contractor's License Law 1'ur one of tine RE-ROOFS:
fullmring five reasons: All roofs shall be inspected prior to any roofing mats,Ind being installed.If. of is
n. I,as owner ofthe 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)
x. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:06/29/2018
1 hereby affirm under penalty of perjury one of tba 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's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work fur which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardaus materials requirements under Chapter 6,95 of the
Section 3700.of the Labor Code,for the perf rmauce of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. ,.!,train compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the 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 my person in any manner so as to become subject to the material.Additionally,should 1 use equipment ur 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 Cuper Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation in of the the Ilenlf 1&Safety Code,Se ion 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:06129, 01 8
I certify that I have read this application and state that the above Information Is CONSTRUCTurtION 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 to Name
to save indemnify and keep harmless the City of Cupertino against Iiabillties,
judgments,costs,and expenses which may accrue against sold 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 06/29/2018
Professional