D-2018-0056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMITNO:D-2018-0056
18851 BARNHARTAVE CUPERTINO,CA 95014-3601(375 16 055) WONG CHING-PING
AND LIM LEYCHEOH
TRUSTEE
18851 BARNHARTAVE
CUPERTINO,CA
95014-3601
OWNER'S NAME: DATE ISSUED:07/23/2018
OWNER'S PHONE: PHONE NO:OWNER BUILDER
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO,
License Class Lid.#
Contractor WONG CHING-PING AND LIM LEYCHEOH TRUSTEE Date —BLDG—ELECT_PLUMB
I hereby aflirm 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 fall force and effect. JOB DESCRIPTION:
DEMO SINGLE FAMILY DWELLING-(814 SF);STORAGE-(86 SF);
I hereby at'Hrm under penalty of perjury one of fire following two declarations: CARPORT-(164 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
performance of the work for which this permit is issued.
I, I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance o£the work for which this
permit is issued, Sq.Ft Floor Are.: Valuation:$10000.00
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 375 16055
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 IIP 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 Data 7/2312018 Issued by:Jeamind Archbold
Date:07/23/2018
OWNER-BUILDER DECLARATION
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.Ira roof is
r. 1,as owncrofmc property,or my employees with wages as their sole installed without first obtaining an inspection,l 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)
CG I,as owner ofthe property,am exclusively contracting with licensed Signaure ofApplicam:
contractors to construct the project(See 7044,Business&Professions Code). Date:7/2312018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOD COVERINGS TO BE CLASS"A"OR BETTERn. I have and will main intaa Certificate of self-insure
Consent to 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 I have and will maintain Worker's Compensation Insurance,as provided for by I have...d the hazardous material,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 with the Cupertino Municipal Code,Chapter 9.12 and the
(..3�)� 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle h.zardous
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
all-contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,alter 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 Codens 2550. 5 J, nd 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be formed,...ked. Owner or authorized agent:
APPLICANT CERTIFICATION Date: 27L2!018
I 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 complywith all non-point our e egulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records,