B-2019-1239BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING
OWNER'S NAME: JERRY WEI AND RACHEL WEI
OWNER'S PHONE: Not Provided
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 11/12/2019 1:42:01 PM
ISSUED BY: HALEYM
VALUATION: $49500
JOB DESCRIPTION
NEW WINDOWS AND (1) PATIO DOOR REV # 1 - REVISE S-1 RELOCATE SHEAR WALL - ISSUED 08/06/2019
REMODEL MASTER BATH - (140 SF); INSTALL (2)
OWNER -BUILDER DECLARATION
the following two declarations:
with wages as their
contracting with licensed
the following two declarations:
consent to self -insure
Insurance, as
for which this permit
this certificate of
be deemed revoked.
role compensation, will do the work, and the structure
contractors to construct the project (Sec. 7044.
is not intended or offered for sale (Sec. 7044, Business
I hereby
affirm under penatly of perjury one of
I, as owner of the property, or my employees
Code).
& Professions
Business & Professions Code).
I, as owner of the property, am exclusively
affirm under penatiy of perjury one of
I have and will maintain a certificate of
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall
I hereby
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under Chapter
9.12 and the Health
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code. Chapter
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
An EPA Lead -Safe Certified Renovator will be responsible for
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
V
CONSTRUCTION LENDING AGENCY
is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there
No
V
Lender's
Name:
APPLICATION CERTIFICATION
state that the above
of this city to enter
judgements, costs,
all non -point source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code. Section 9.18.
I certify that I
construction,
harmless the
the applicant
Signature:
have read this application and
and hereby authorize representatives
City of Cupertino against liabilities,
understands and will comply with
.