B-2018-1398 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDIl CONTRACTOR: PERMIT NO:B-2018-1398
11135 LA PALOMA DR CUPERTINO,CA 95014-4772(356 I6 035) HOME NETWORKS,
ELECTRIC&SOLAR
SAN JOSE,CA 95131
OWNER'S NAME:Man John C And Tang Flora S DATE ISSUED:08/20/2018
OWNER'S PHONE: PHONE NO:(
LICENSEDR T DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lia#820184 X BLDG_ELECT—PLUMB
Contractor HOME NETWORKS ELECTRIC&SOLAR Date 05/31/2019 —
1 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:
(N)EV CHARGING STATION(50 AMP)-GARAGE
I hereby affirm under penalty of perjury one of dm following two declarations:
t. I have and will maintain a certificate of conscut 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.
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.III Floor Area: Valuation:$2800.00
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: Occnpancy'lype:
and state laws relating to building construction,and hereby authorize 356 16035
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 WORT{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 08/20/2018 Issued by:Jasmine Archbold
Date:08/20/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt Broin the Contractor's License Law to,.one of the -1
200PS:
following tvvo reasons: All roofs shall be inspected prior tr any roofing material being installed.If a roof is
installed without first obtaining'n n inspection,1 agree to remove all new materials for
L I,as owner of the property,Or my employees with wages as their sole °ISP g
compensation,will do the work,and the structure is not intended or offered for inspection
sale(See.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicanu
contractors to construct the project(S-7044,Business&Professions Code), Date,08/20/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
m. 1 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. - HAZARDOUS MATERIALS DISCLOSURE
z. 1 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.I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permi[is issued. n un
Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. 1 certify that in they person in of the work for which this subje is issued,1 material.Additionally,should 1 use equipment ar devices which craft hazardous
shall not employ any person in any manner so as to become subject to the air contaminants ns dented by the Bay Area At,-Quality Management District I
Werker's Compensation laws of California If,eller making this certificate of will maintain compllmnce 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,Sections j5505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIMCATION 'Date:08/20/2018
I certify that I have read this application and slate that the above information isCONS'I'RUC'I'TON TJ2NDTNGAGENCY
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.
Signature Date 0 812 0/2 01 8 Licensed
Professional