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B-2018-1635CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-1635 1508 ASTER CT CUPERTINO, CA 95014-5213 (366 16 045) Pang Sandra Me Tan Trustee & Et Al 1508 Aster Ct Cupertino, CA 95014-5213 OWNER'S NAME: Pang Sandra Me Tan Trustee & Et Al OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Pang Sandra Me Tan Trustee & Et AI Date 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 license is in full force and effect. 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 -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. 2. 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. . APPLICANT CERTIFICATION 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date I hereby affirm that f am exempt from the Contractor's License Law for one of the following two reasons: t. 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (See .7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, For the performance ❑fihe work for which this permit is issued. 3- 1 certify that in the performance of the work For which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of CaIifornia. If, after making this cert ifrcate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I most forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CANT CERTi.FICAT[OON certify that I have read this application and state that the above information is :orrect. I agree to comply with all city and county ordinances and state laws -elating to building construction, and hereby authorize representatives of this city :o enter upon the above mentioned property for inspection purposes. (We) agree o save indemnify and keep bar less-th City of Cupertino against liabilities, udgments, costs, and expe es which ;ay accrue against said City in :onsequence of the grantin of this permit. Additionally, the applicant understands and will comply with all non- int soyrce regulations per the Cupertino Municipal ,ode, Section 9.18. ISSUED: 10/18/2018 PHONE NO: BUILDING PERMIT INFO: X BLDG —ELECT -PLUMB _ MECH X RESIDENTIAL, _ COMMERCIAL JOB DESCRIPTION: REMODEL BATHROOM NEAR LAUNDRY AREA LIKE FOR LIKE - ( 70 SF) REV #1: CLOSE (E) GARAGE MAN DOOR - ISSUED 10/18/2018 Sq. Ft Floor Area: I Valuation: $4000.00 APN Number: Occupancy Type: 366 16 045 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Phuong Devries RERQQFS: All roofs shall he inspcctcd prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 09/24/2Q 18 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I stare or handie hazardous material. Additionally, should I use -quiprnept or devices which emit hazardous air contaminants as defined by th"ay Area. -Air Quality Management Districl I will maintain compliance with th�e Cuperti o Municipal Code, Chapter 9.12 and the Health & Safety C$de, pe • ns 25505, 25533, and 25534. ,, Owner or authorized agent: Date: CON$TR11CTION LENDING A =EN .Y I hereby affirm that there is a construction lending agency fo theerformance of work's for which this permit is issued (See. 3097 Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1635 1508 ASTER CT CUPERTINO,CA 95014-5213(366 16 045) PANG SANDRA ME TAN TRUSTEE&ET AL 1508 ASTER CT NO,CA 95014-5213 i A 09/24/2018 OWNER'S PHONE:408-219-2833 PHONE NO:None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor PANG SANDRA ME TAN TRUSTEE&ETA Date X BLDG —ELECT —PLUMB I hereby affirm 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 full force and effect. JOB DESCRIPTION: REMODEL BATHROOM NEAR LAUNDRY AREA LIKE FOR LIKE- I hereby affirm under penalty of perjury one of the following two declarations: (70 SF) 1. 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. 2. 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:$4000.00 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 366 16 045 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 09/24/2018 Issued by:Jasmine Archbold Date:09/24/2018 OWNER-BUILDER DECLARATION 1 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.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I 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) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/24/2018 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 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 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 permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use e ' t or devices which emit hazardous air contaminants as defined by t ay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with t e Cupertio Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&SafetyC de,Sec' ns 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall \ be deemed revoked. Owner Or authorized agent: APPLICANT CERTIFICATION Date:09/24/2018 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 fo the rformance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097r6io C. to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keephar City of Cupertino against liabilities, judgments,costs,and expe es which ay accrue against said City in Lender's Address consequence of the gra ntin of this per it. Additionally,the applicant understands and will comply with all non- int so ce regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records.