BLD-2020-0872 ITY OF
BUILDING PER IT
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PHONE 408-777-3228
'CUPERTINO WWW.CUPERTINO.ORG
BUILDING ADDRESS:
10218 PARK CIRCLE E, APT# 1 CUPERTINO, CA
APN:
326 32 008
PERMIT NO: BLD-2020-0872
OWNER'S NAME TANG ELIZABETH CHING-LAN
OWNER'S PHONE: (650)346-8885
CONTRACTOR: owner builder
CONTRACTOR PHONE:
DATE ISSUED:7/17/20
ISSUED BY: haleym
VALUATION:40,000
JOB DESCRIPTION:
REMODEL KITCHEN (57 SF); REMODEL BATHROOM (40 SF) ; INSTALL (9) RECESSED LIGHTS; REPLACE SUB -PANEL SAME
LOCATION- (100 AMP); REPLACE WINDOWS AND DOORS LIKE FOR LIKE - (4)
OWNER -BUILDER DECLARATION:
Law for one of the following two
with wages as their role compensation,
& Professions Code).
reasons:
will
to construct
Section 3700
not employ
this certificate
with
do the work, and the structure is not
the project (Sec.7044, Business &
as provided for by Section 3700 of the
I hereby affirm that I am exempt from the Contractor's License
❑ I, as owner of the property, or my employees
1 intended or offered for sale (Sec. 7044 Business
I I, as owner of the property, am exclusively contracting
Profession Code).
I hereby affirm under penalty of perjury one of the following three
❑ I have and will maintain a Certificate of Consent
Labor Code, for the performance of the work
with licensed contractors
declarations:
to self -insure for Worker's Compensation,
for which this permit is issued.
Insurance, as provided for by
is issued.
for which this permit is issued, I shall
laws of California. If, after making
Labor Code, 1 must forthwith comply
of the Labor Code, for the
any person in any manner so as to
of exemption, I become subject to
such provisions or this permit shall be
❑ I have and will maintain Worker's Compensation
,7 performance of the work for which this permit
V I certify that in the performance of the work
become subject to the Worker's Compensation
the Worker's Compensation provisions of the
deemed revoked.
HAZARDOUS MATERIALS DISCLOSURE
6.95 of the California Health & Safety Code, Sections 2.5505, 25533, and 25534. I
i� I have read the hazardous materials requirements under Chapter
will maintain compliance with the Cupertino Municipal Code,
Chapter 9.12 and the Health &
Safety Code,
air contaminants
Chapter
No:
Section 25532(a) should I store or
as defined by the Bay Area
handle hazardous material. Additionally, should I use equipment or devices which emit hazardous
Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,
Sections 25505, 25533, and 25534.
❑ An EPA Lead -Safe Certified Renovator will be responsible for this project.
/ Certified Firm Name: Firm Certification
9.12 and the Health & Safety Code,
V No EPA Lead -Safe Certified Firm is required for this project.
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued
I hereby affirm under penalty of perjury that there is a construction
(Section 8172, Civil Co
❑ Yes No
Lender's Name:
Lender's Address: