B-2017-1301CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1301
19200 TILSON AVE CUPERTINO, CA 95014-3529 (375 40 061)
RADIANT HOME
CONSTRUCTION LLC
CUPERTINO, CA 95014
OWNER'S NAME: LEE JOHN C AND NGUYEN NGOC
DATE ISSUED: 08/07/2017
OWNER'S PHONE: 650-862-6828
PHONE NO: (408) 888-2898
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #k#56154
Contractor RADIANT HOME CONSTRUCTION LLC Date 03/31/2019
X BLDG X ELECT _ PLUMB
MECH X 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 Cade and that my
license is, in full force and effect.
JOB DESCRIPTION:
TEMP POWER (100 AMP)
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.
z. have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor C.for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $500.00
permit is issued:.
APPLICANT CERTIFICATION
I certify that I have read :this application and state that the above
APN Number:
Occupancy Type:
information is correct. l agree to comply with all city and county ordinances
375 40 061
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue al ainst said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, th applicant•understands and will comply with all non-point
source regulati ns per• the C pertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08f7/2017
Issued by: Kim Dunbar
I
Date: 08/07/2017
OWNER-BUILDER' DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF 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)
z. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors tb constrict the project (Sec.7044, Business & Professions Code).
Date: 08Z7/201
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; inairitain 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
I "iI ' - v
permit: is issued.1
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Section 25532(a) I handle hazardous
3. I cemfy thatui tlielp'e.11'rformance of the work for which this permit is issued, I
•i! i.i
become to the
Health & Safety'Code, should store or
material. Additionally, should I use equipment or devices which emit hazardous
Y�
shall not employ any person in any manner so as to subject
Worker's Compensation laws California. If, this certificate of
air contaminants as defined by the B Area Air Quality Management District I
9.12
of after making
will maintain compliance with the upertino Municipal Code, Chapter and
exemption I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code 1 I m&t forthwith comply with such provisions or this permit shall
be d1eemed,revoked."
Owner or authorized agent:
APPLICANT CERTIFICATION
information is
Date: 08/7/2017
O TR TIO L ND AGENCY
I certify that I have read this application and state that the above
correct. I agree to comply wdh all city and county ordinances and state laws
I hereby affirm that there is a constructio 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 they above mentionedproperty for inspection purposes. (We)agree
Lender's Name ;
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments cost's; and expenses which may accrue against said City in
Lender's Address
consequence of-the grantirig this permit. Additionally, the applicant understands
of
and will comply'wlthjail ;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 4$/7/2017
Professional
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR - ❑ CONTRACTOR AGENT ❑ ARCHITECT ' ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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USE OF ;3SFD or DUPLEX ❑ MULTT-FAMTLY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAATD ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN ❑ YES
FLOOD ZONE NO
i5 THE BLDG AN ❑ YES
EICHLER HOME? NO
DESCRIPTIONTT OF WORK'
TOTAL VALUATION: �O�
RECE
By my signature below, I certify to each of the following: la the property ow er or authorized agent to act on the property- owner's behalf. I have read this
application and the information I have provid is correct. have read the De ription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin construction. aut rize re sentatives of Cupertino to enter the abo id itifi dyroerty for inspection purposes.
Signature ofApplicant/Agent: Date:7
SUPPLEM AL VFORMATION REQUIRED
oFFicE IJss o vLi
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❑ pOVER THE COUNTER - ,
c. r
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❑ EXRRESS
❑ STANDARD 62.,
❑ LARGE
F
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11