B-2018-1254 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1254
20720 GARDEN MANOR CT CUPERTINO,CA 95014-5066(362 30 071) LAI TERRY K AND
LAI-CHEANG PEGGY
M
20720 GARDEN
MANOR CT
CUPERTINO,CA
95014-5066
OWNER'SNAME: DATE ISSUED:07/26/2018
OWNER'S PHONE: PHONE NO:None
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic,#
Contractor LAI TERRY KAND LAI-CHEANG PEGGY M Date X BLDG X ELECT_PLUMB
I bereby affirm that I am Ilcensed under the provisions of Chapter 9(commencing —MECII X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Bnsiness&Professions Code and that my
license Is in fall farce and effect, JOB DESCRIPTION:
INSTALL(12)RECESSED LIGHTS FAMILY/LIVING/KITCHEN ROOM
I hereby affirm under penalty o£perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of dre Labor Code,for the
performance of the work for which this permit is issued.
z. I have anti 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 Arco: Valuation:$1000.00
APPLICANT CERTIFICATION
I certify that I have read this application and slate 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 362 30071
representatives of this city to enter upon the above mentioned properly for
inspection purposes.(We)agree to save Indemnify and keep harmless the
City of Cupertino against liabilities,judgments,casts,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
Addltionally,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 07/26/2018 Issued by:Jasmine Archbold
Date:07/25/2018
OWNER-BUILDER DECLARATION
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 aftl,e work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements order Clmpter 6.95 of the
Section 3700 of the Letter Cade,for the performance of the work for which this California Health&Safety Cade,Steal—25505,25533,and 25534.1 will
Permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 anti the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store m•handle hazardous
shall not employ any person is any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
.In contnmimrts as detiued [he Bay Aran Ah-Quality MxnnyyemenI District I
Worker's Compensation laws of California.If,after making this certificate of will maintain complfonce wit
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction le ding 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 enterupon the above mentioned property for Inspection purposes. (We)agree Lender's Name
to save Indemnify and keep harmless the City of Cupertino against Ilabllities,
Judgments,costs,and expenses which may accrue against said City In Lender's Address
consequ nce of the granting of lhl permit.Additionally,the applicant understands
and will c
O 1 understand my plans shall be used as publlc records.