D-2018-0062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0062
21921 MCCLELLAN RD CUPERTINO,CA 95014-4035(357 14 011) SUI DONG CHEN
CONSTRUCTION
DUBLIN,CA 94568
OWNER'S NAME: DATE ISSUED:08/15/2018
OWNER'S PHONE: PRONE Na(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ LIc.#1041832
Contractor SW DONG CHEN CONSTRUCTION Date 07/31/2020 —BLDG—ELECT—PLUMB
I hereby affirm that f nm licensed ander the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL
with Section 7000)at'Division 3 of the Business&Professions Code and that my
license is fn full force and effect. JOB DESCRIPTION:
DEMO DETACHED GARAGE-(400 SF)-AFTER-THE-FACT
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insore for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
7C'' performance of the work for which this permit is issued,
z. 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 Fluor Arca: Valuation:$5000.00
APPLICANT 111 ION
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 357 14 011
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 08/15/2018 Issued by:Jasmine Archbold
Date:08/15/2018
OWNER-BUILDER DECLARATION
I hereby afilm.that I am exempt from the Contractor's License Law t'or one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any ruofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,1 agree to remove all new mEnei ials for
compensation,will do the work,and the stricture is not intended or offered far inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicanu
contractors to construct the project(See.7044,Business&Professions Code). Date:08/15/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure to 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 read the hazardous materials requirements tinder 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.I will
1 t Is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the
pc mr health&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I material.Additionally,sl ould I use equipment or devices which,nit hazardous
shall not employ any person in any manner so as to become subject to the .air contaminants as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of CaliForniu,IC,atter making This certifmate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
.emptier,I become subject to the Worker's Compensation provisions of the the health&Safety Code,Sections 25505„;5533,.and 25534.
Labor Cade,I must forthwith comply with such provisions or this permit shall •(
APPLICANT CERTIFICATION Date:06/15/2018
1 certify that I have read this applicallon 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 ARCI1TI'EC'1M S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 08115!2018 Professional
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