B-2018-0591 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0591
10399 NORMANDY CT CUPERTINO,CA 95014-3109(369 29 021) LIU DONGTAO AND
ZHANG MENG
10399 NORMANDY CT
CUPERTINO,CA
95014-3109
OWNER'S NAME: DATE ISSUED:04/11/2018
OWNER'S PHONE: PHONE No:N
LICENSED CONTRACTOR'S
DECLARATION BUILDING PERMIT INFO:
License Class Lc.#
Contractor LIU DONGTAO AND ZHANG MENG Date X BLDG_ELECT PLUMB
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code snit that my
license is in full force and effect. JOB DESCRIPTION:
RE-ROOF;TEAR-OFF;INSTALL CDX;ASPHALT SHINGLES-(I6 SQ)
I hereby affirm under penalty ofpsrjury one of the following I—declarations:
t. 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,
z. I have and will maintain Worker's Compensation Insurance,as provided Por by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$10000.00
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 36929 021
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 1S 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 Data 04/11/2018 Issued by:Jasmine At
Date:04/11/2018
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Lmv for one of the RE-ROOFS:
following hvo roasons All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without fust obtaining an agree to remove all new materials for inspection,I
Xi 1,as owner of the property,or my employees with wages as their sole P
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 ofthc property,am exclusively contracting with licensed Signature of ApplicanC
contractors to construct the project(Sec.7044,Business&Professions Cade), Date:04/11/2018
I hereby affirm under penalty of perjury one a£the fallowing three dechtrationse ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER^s,& I have and will maintain a Certificate of Consent to sciNnsure 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 lines 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 Cade,Sections 25505,25533,and 25534.1 will
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 Oris permit is issued,I Health&Safety Code,Section 25532(n)should I stare at-handle hazardous
shall not employ any person in any manner ee as m become subject to the material.Additionally,Should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Arca Air Quality Management District I
Worker's Compensation laws of California.If,ager making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,1 become subject to the Worker's Compensation provisions of the the Health&Safety
Labor Cade,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:04/11/2018
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 ARC4L1M'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 04/11/2018 Licensed