B-2018-1162 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1162
DI Ll CONSTRUCTION
COMPANY INC
SARATOGA,CA 95970
OWNER'S NAME:Liu Yen And Zhu Jun DATE ISSUED:07/10/2018
OWNER'S PHONE: PHONE NO:(408)866-6238
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 8 Lic.#6Z 888-Q
Contractor DI LI CONSTRUCTION COMPANY INC Date 01/31/2020 X BLDG ELECT_PLUMB
I hereby aMrm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)orDivision 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMODEL KITCHEN-(150 SF);REMODEL(2)BATHROOMS-(log
I hereby affirm under penalty of perju y one ofthe following two declarations: SF);
r. 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
erformance of the work for which this permit is issued.
tthave and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance ofthe work for which this
permit is.issued. Sq.Ft Floor Area: Valuation:$30000,00
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'lype:
and state laws relating to building construction,and hereby authorize 34245 027
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 07/10/2018 Issued by:Jasmine Archbold
Date:07/10/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the -ROOFS:
]'allowing two reasons: All roofs shell he inspected prior to any roofing material being installed.If a roof is
u 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 slruchue is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:07/10/2018
1 hereby affirm under penalty ofperjury one a]the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-insure far Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of the work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by 1 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. nm aintain compliance with the Caper than Municipal Code,Chapter 9.12 and the
s. I certify that in the performance ofthe work for which this permit is issued,I Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the rr contaminants ateernm
al.Addltiodly,should 1 use equipment nrdevices which emit hazardous
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 cf the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall _ r
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Data:07/10/2018
I certify that I have read this application and stale 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.
Licensed
Signature Date 07110/201 8 Professional