B-2018-1131 CITY OF CUPERTINO BUILDING PERMIT
rBUILDING ADDRESS: ONTRACTOR: PERMIT NO:B-2018-1131
YRTLEWOOD DR CUPERTINO,CA 95014-4626(369 20 02 1);4SERVICES
B CONSTRUCTION
INC
ASTRO VALLEY,CA
546
DATE ISSUED:08/30/2018
OWNER'S NAME: Lin Linda
pnONE NO.(
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 5 Lic.#1001862 XBLDG X ELECT _PLUMB
_
Contractor H B CONSTRUCTION SERVICES INC Date 03/31/2019 _MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
license is in full force and effect.
FIRST FLOOR ADDITION A.D.U.(407 SF);REMODEL OTHER(41
I hereby affirm under penalty of perjury one of the following two declarations: SF);PANEL UPGRADE AT MAIN RESIDENCE(200 AMP).
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
performance of the work for which this permit is issued.
;City
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 Floor Area: Valuation:$265000.00
APPLICANT CERTIFICATION
that I have read this application and state that the above rVU
: �R-3
�(Custom)
pe:
tion is correct.I agree to comply with all city and county ordinances 36920021
te laws relating to building construction,and hereby authorize
ntatives of this city to enter upon the above mentioned property for
on purposes. (We)agree to save indemnify and keep harmless the
Cupertino against liabilities,judgments,costs,and expenses which IT 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 ate 08/30/18 Issued by:Haley McKee
Date:08/30/2018
OWNER-B LDER DECLARATION
RF-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without fust obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of A hcant:
2. I,as owner of the property,am exclusively contracting with licensed Dt : 30/18 p
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit 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 I
Worker's Compensation laws of California. If,after 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 Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
�unr*rexT f FRTIFICATION Date:08/30/18
CON TR ON LE G G
I certify that I have read this application and state=hat above information is I hereby affirm that there T a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit o issued(Sec. ding a Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
-inature Date 08/30/18 Professional