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Home My WebLink AboutB-2017-2077 Permit + Rev 1CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-2077 20273 NORTHCOVE SQ CUPERTINO, CA 95014-0505 (316 4l 041) OWNER BUILDER OWNER'S NAME: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. If Contractor OWNER BUILDER Dale X BLDG 7S ELECT _PLUMB MECH $ 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 Beene is in full force and effect. JOB DESCRIPTION: HALLWAY BATHROOM REMODEL (70 S.F.); KITCHEN REMODEL I hereby affirm under penalty of perjury one of the following two declarations: (100 S.F.) 1. I have and will maintain a certificate of consent to self -insure for Worker's REV #1 - REPLACE AND RELOCATE SUB PANEL (100 AMPS) Compensation, as provided for by Section 3700 of the Labor Code, for the 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 Floor Area: Valuation: $15000.00 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 316 41 041 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 against said City in consequence of the granting of this permit Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 3/2/2018 Issued by: Abby Ayende Date: 12/05/2017 OWNER -BUILDER DECLARATION 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 1. I, as owner of the property, or my employees with wages as their sole installed without fust 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 Code) (�-1-I— I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: 1/2/2018 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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. 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 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 permit is issued, maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. 1 certify that in the performance of the work for which this permit is issued, I Health & Safety Cade, 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 [his 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 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall � be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION CERTIFICATION Date: 3/2/2018 I certify that I have read this application and state that the above information Is CONSTRUCTION LE II G AGE C correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agenc feLjhe erformance 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. 1 understand my plans shall be used as public records. Signature Date 3/2/2018 Licensed Professional FrA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-2077 20273 NORTHCOVE SQ CUPERTINO, CA 95014-0505 (316 41 041) HOMEOWNER BUILDER OWNER'S NAME: FUNG MICHAEL G AND TRACIE C TR 'S DECLARATION BUILDING PERMIT INFO: License Class Lic; # Contractor HOMEOWNER BUILDER Date X BLDG _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 Code and that my license is in full force and effect. JOB DESCRIPTION: HALLWAY BATHROOM REMODEL (70 S.F.); KITCHEN REMODEL thereby affirm 'under penalty of perjury one of the following two declarations: (100 S.F.) m. 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. 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 Sq. Ft Floor Area: Valuation;. $15000.00 permit is issued. 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 316 41 041 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 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 I ource regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 12/5/2017 Issued by: Abbyyende Date: 12/05/2017 OWNER -BUILDER DECLARATION I hereby affirm thaf'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 1. I, as owner of the property, or my employees with wages as their sole installed without fust 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. ale (Sec.7044, Business & Professions Code) as owner of the property„am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12/5/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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 of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE ��formance Iave 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 permit is issued, maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I ccrtify 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 Area Management air contaminants as defined by the Bay Air Quality 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 255 , 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. or authorized agent: �Date: APPLICANT CERTIFICATION 1215/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING correct. I agree to complywith all city and county ordinances and state lawsI hereby affirm that there is a construction lending agen he 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 Cupertinoagainst 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! 9.1'8. 1 understand my plans shall be used, as public records. Licensed ignature Date 12/5/2017Professional M