B-2018-1124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1124
10670 LARRY WAY CUPERTINO,CA 95014-2057(316 02 O4) MS
SERVICES INC
HAYWARD,CA 94545
OWNER'S NAME:MARIAN VIKAS AND YAO JINGSHI DATE ISSUED:07/03/2018
OWNER'S PHONE: PHONE NO:(510)887-5571
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#1009199
Contractor M S SERVICES INC Date 11/30/2019 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
REPLACE AC WIT-SAME LOCATION
I hereby affirm under penalty of perjury one of the fallowing two declarations:
t. I have and will maintain a certificate o£consent to self-insure for Worker's
r Compensation,as provided for by Section 3700 of the Labor Code,for the
lD performance of the work for which this permit is issued.
z 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 Float,Area: Valuation:$3000.00
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 stale laws relating to building construction,and hereby authorize 31602 034
representatives of this city to enter upon the above mentioned properly 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 inconsequence of oJJm granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and wi���omply with all non-point
source regulation per the upertino Munl'flal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 0 710 3/2 01 8 Issued by:Jasmine Archbold
Date:07/03/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the Mt,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.Unroof is
r. 1,as owner of the property,or my employees with wages as their sale 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(Sce.7044,Business&Professions Cade)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to a.maruct the project(Sce.7044,Business&Professions Code). Date:07/03/2018
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 maintains 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. 1 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 far which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance ofthe work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I stare or handle hazardous
shall not employ any person in any manner so as to become subject to the material,Additionally,should I ase equipment or devices whleh emit hazardous
oilcontaminants as dalined 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 Cade,S c�105,25533,nad 2553
Labor Code,I must forthwith comply with such provisions or this permit shall
be deenned revoked. Owner or authorized agent:
APPLICANT CERTHUCAT[ON Date:0710312018
I certify that I have read this application and slate 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-polnl source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 07/03/2018 Licensed
Professional