B-2018-1409 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1409
20666 CLEO AVE CUPERTINO,CA 95014-5033(362 31 001) XIANG SHANG LI
CUPERTINO,CA 95014
OWNER'S NAME: DATE ISSUED:08/21/2018
OWNER'S PHONE: PHONE NO:(
LI BUILDING PERMIT INFO:
License Class C10 Lie.#784387 X BLDG X ELECT_PLUMB
Contractor XIANG SHANG LI Dale 09/30/2020 —
I hereby affirm that I.m licensed under the in rovisions of Chapter 9(commencing —MECR X RESIDENTIALCOMMERCIAL
with Section 7000)ol'Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
PANEL UPGRADE(200 AMP)
I hereby affirm under penalty of perjury one or the following two declarations:
t. 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
performzneo of the work for which this permit is issued,
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 Floor Arca: Valuation:$2200.00
APP J.ANT 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 slate laws relating to building construction,and hereby authorize 36231 001
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. WITIIIN 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 8-21-2018 Issued by:Kim Dunbar
Date:08/21/2018
OWNER-BUILDER DECLARATION
I hereby al'lirm 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.If.of is
t. 1,as owner,of the property,or my employees with wages as their sole installed without f rat obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the struct—is not intended or offered for inspection.
sale(Sec.7044,Business&.Professions Code)
s. f,as owner of the property,am exclusively contracting with licensed Signature ofApplicaut:
contractors to construct the project(Sce.7044,Business&Professions Code), Date:8-21-2018
1 hereby affirm tinder penalty of perjury one of the yellowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to sol Finsure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work fm which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insm once,as provided for by I have read tine 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
i It is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
pert Health&Safety Corte,Section 25532(.)shm ld I store or handle hazardous
I, I certify that in the anof the work for which this permit is issued,) material.Additionally,should I use equipment or devices which emit hazardous
shall not employ anyy person inn any manner so as m become subject to the air conlaminonts as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,ager making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Workers Compensation provisions of the the Health&Safety Code,Sections 25505 25533,and 255r3ji.
Labor Code,I must forthwith comply with such provisions or this permit shall
Owner or authorized agent:
APPLICANT CERTIFICATIQiy Date:8-21-2018
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.Additlonally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITEC]"S DECLAI2A'f'ION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 8-21-2018 Licensed
Professional