BLD-2020-0418BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10240 STERN AVE CUPERTINO, CA 95014-
OWNER'S NAME: YUN JUNG SUK AND FUNG SUE HUNG
OWNER'S PHONE: Not Provided
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 9/3/2020 2:22:15 PM
ISSUED BY:
VALUATION: $20000
JOB DESCRIPTION
(CONDITION TO FINAL RELATED PERMIT B-2017-0420 WITH NEW ENGINEER'S PLANS)
CONVERT (E) CARPORT TO 1-CAR GARAGE
OWNER -BUILDER DECLARATION
one of the following three
with wages as their
contracting with licensed
one of the following two declarations:
of consent to self -insure
Insurance, as
the work for which this permit
making this certificate of
shall be deemed revoked.
declarations:
role compensation, will do the work, and the structure
contractors to construct the project (Sec. 7044,
is not intended or offered for sale (Sec. 7044, Business
I hereby
affirm under penatly of perjury
I, as owner of the property, or my employees
Code).
& Professions
Business & Professions Code).
V
I, as owner of the property, am exclusively
affirm under penatiy of perjury
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of
laws of California. If, after
with such provisions or this permit
I hereby
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
9.12 and the
Chapter
Health
as
Sections
6.95 of the California Health & Safety Code. Sections 25505, 25533. and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
will be responsible for this project.
Firm Certification No:
required for this project.
An EPA Lead -Safe Certified Renovator
Firm Name:
No EPA Lead -Safe Certified Firm is
Certified
V
CONSTRUCTION LENDING AGENCY
that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and
state that the
of this
judgements,
with all non -point
.