B-2018-1163 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1163
BAY BATHROOMS
AND KITCHENS INC
SAN JOSE,CA 95129
OWNER'S NAME:Chen Len R And Katy H Trustee DATE ISSUED:07/10/2015
OWNER'S PHONE: PHONE NO;(405)595-6531
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 5 Lic.#968252
Contractor BAY BATHROOMS AND KITCHENS INC Date 06/30/2020 X BLDG ELECT_PLUMB
I hereby affirm that 1 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:
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL BATHROOM-(103 SF)LIKE FOR LIKE
t. 1 have and will maintain a certificate ofcouseut to self-insurc for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this per is issued.
,,(/z. I have and will maintain Worker's Compensation Insurance,as provided for by
-J'r Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Flaor Area: Valuation:$42272.00
APPLICANT CERTIFICATION
I certify that I have read ails appllcatlon and slate that the above
Information is correct.I agree to comply with all city and county ordinances APN Number: Occupmwy'lype:
and slate laws relating to building construction,and hereby authorize 32647 034
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 WORI{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 07/10/2018 Issued by:Jasmine Archbold
Date:07/10/2018
OWNER-BI3111DER DECLARATION
I hereby affirm that I no exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
u. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agive to remove all new materials for
ompensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Cade)
z. 1,as owner ofthc property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec,7044,Business&Professions Code), Date:07/10/2018
1 hereby affirm under penalty o1perjury 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 selMosaue 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. J 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 25534.1 will
permit is issued maintain compliance wit],the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance all work for which this permit is issued,I Health&Safety Code,Section 25532(x)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 hazardous
r contaminants as defined by doe Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate oC will maintain emnpliance 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,Secr ei s 505,25533,anrl25 4.
Labor Code,l must forthwith comply with such provisions a this permit shall // —//'
be deemed revoked. Owner or authorized agent:
APPLICANT CERTf FICATION' Data:07/10/2018
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 ITLCT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
SignatureLicensed
Data 07/1012018
Professional