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B-2017-1845 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1845 21991 OAKNOLL CT CUPERTINO,CA 95014-1110(326 39 017) STREET PLUMBING AND ROOTER SAN JOSE,CA 95128 OWNER'S NAME: LIN SHAOBIN AND ZENG WEIQI DATE ISSUED: 10/27/2017 OWNER'S PHONE:408-784-8958 PHONE NO:(408)496-1155 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#582217 Contractor STREET PLUMBING AND ROOTER Date 12/31/2017 • X BLDG _ELECT X PLUMB MECHX 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 license is in full force and effect. JOB DESCRIPTION: REPLACE 40 GAL WATER HEATER-SAME LOCATION 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 FS Compensation,as provided for by Section 3700 of the Labor Code,for the 00 J 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:$1300.00 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 326 39 017 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City:ofCCupertino 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 10/27/2017 Issued by:AbbyAyende Date: 10/27/2017 OWNER-BIIILDER DECLARATION is I 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 111. 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:10/27/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I have and will maintain a Certificate of Consent to self-insure for Worker's ii' Compensation,as provided for by Section 3700 of the Labor Code,for the i: performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 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 3760 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will j 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 equipment or devices which emit hazardous 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 505,25533,and 25534. Labor Code,I must forthwith comply with such provisions'or this permit shall - w�' be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:10/27/2017 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. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION . Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 10/27/2017 Professional ii 1--ion--- Ii :: ' J GENERAL PERMIT APPLICATION - - 412' COMMUNITY DEVELOPMEN f DEPARTMENT.*BUILDING DIVISION • 10300TORREAVENUE=CUPERTINO.CA 95014-3255 . . M I S C .. • CUPERTINO- (408)777-3228-FAX 0:M777-3333•buildinnacuperlinoori - PLUMBWG D CAI. DELECTRICAL DMIS 0US • P7EcrADDREss 2I Rtel./ - 040V©LL C 2r .A# 3320 -- -Y1-01 _ • O[llI�RI4Al9E / PH A gq_8 q 31 E-IdAII. sr rADifilthS 2/'q / 04 �. ft-A)° bt.. rte= Nit , CA- 9��4-",. CONTACT NAME MA 2k STj2Ert - 1��//pp//'� . , - X04 4%- IIST n7t ifl'Pd ptturtbf Q etr t " SCBE DDREss .22 93 Wain/ Grn tot- / `J � �✓c �.��sa,►,�sc. CA 9�i28 FAX�g_�¢96,-!lSS. o-owe 0 oaNstat fl Q owra aoear colaRacivR 0 cceaucTeRAGEN7 ElAndU Ecr. Da mama. 0 DEVELOPER 0 TENANT: comsacroR.nuts M( (STAtc C- - LICENSENumBER58z217 - - ucEiesErns C'3 G sus1!C ,o g 6,3 colvII+aNYNAME c n-VLM�31N6 I OM. rift,s0r- I1cvdot' a Ai),aw FA7C ,0 d)476-63 STREET ADDRESS.. 2:2 93 WPI NA- rDie.,Ayc/ .sr z� :, ,, ,,, Qn,�a s-C- 01-�sr2 08 1. , 910 � AR LEENSENUMBER - BUS.IICO MADAM'NAM -E-14A31. - FAX . SFREETADDRESS UT SrATE,ZJ - PHOIIE - 'USE"OF 4 arm or Duplex 9 Multi-Family PRO/ECt]N MIDLAND - P1tQiECC]!)7 -- MINIMUM- ❑ Cotnmeccial - - =BAN-nirERFACEARE ❑ Yes - 0 NO " PLooDzoNs 0 Yes 0 No DEsc�l]ortaFwoR<c 4Oz//4 . �{'-6 kg-t..4--t-r— ( ' :. <5.41rK-t fbc-e-4\ _ - . ,„ • TeiTVALLAT]V,Y: w,- iiia ,-- Y >+-- - Bym ysignatmebelow,Icertfytoea&oftthefollowiag 1 , owner or ;nawait toactonthepsopatyowaa'sbebai£Ihavenadihis _ application andtleinformation ILave�,• =•.iss• ..,. ,� readee a ,* "orkandvth�..!r�iwtisacc .laag�ieetocomply widta]lapplicable]oval . ordinances and state]aws : .uliQ.:.,ug,.._ T;T, • '. • n' w❑,`,11-11 ,' 1„:.Ili,tOenta tlieabove-ideabfi SignanaeofApplicant/Agent /%Mf — De / Pro' 1 P@p a-' rtro O' •TION ' . I. ” � n'l _ Y - R-_L. ',- - '&-f,,•::"-_.,4 � �,,•::"✓ .....4.f-,c-may-- tip' #-^�.'l r =i= cy--. t - - - MEPilf scApp 2011.doe revised 03/16/11