B-2018-1156 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR:. PERMIT NO:B-2018-1156
7524 HEATHERWOOD DR CUPERTINO,CA 95014-5841(359 28 046) Kwan Terence Nang
Chong Trustee&Et At
22330 Santa Paola Ave
Cupertino,CA 95014
OWNER'S NAME:Kwan Terence Nang Chong Trustee&Et AI DATE ISSUED:07/10/2018
OWNER'S PHONE: PHONE NO:408-464-5030
IC BUILDING PERMIT INFO:
License Class Lic.#
Contractor Kwan Terence Nang Chong Trustee&Et At Date X BLDG X ELECT_PLUMB
I 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 and that my
license is in full force and effect. JOB DESCRIPTION:
(N)TEMPORARY POWER-(200 AMPS)
I hereby affirm under penalty of perjury one of the following two 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 die Labor Code,for the
performance of the work for which this permit is issued.
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Lubm Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Vahmtimo$600.00
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 35928 046
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
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/10/2018 Issued by:Jasmine Archbold
Date:07/10/2018
/ OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one a]the RE-ROOFS:
following two reasons: All root's shall be inspected prior to any roofing material being installed.If.roof is
1. I,as owner of the property,or my employees with wages as their sole iru,talled without first obtaining au 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)
1,as owinci oftthe property,am exclusively contracting with licensed Signature ofApplicant
contractors to conshuct the project(Sea 7044,Business&Professions Cade), Date:07/10/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
�. 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation lasumnce,m 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 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,IIlealth&Safety Code,Section 25532(a)should I store or handle hazardous
shall net employ any person in any manner so as to become subject to the 1 nnterinl.Additionally,should I use equipment or devices which emit hazardous
air contuninants as deRued by the Bay Area Air Quality Management District I
Worker's Compensation laws oYCalifornia,If,ull 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 the the Health&Safety Code,Sections 25505,25533,5,25533, n
Labor Code,i must forcomply onnply with such In or this permit
shalt
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:0711012018
I certify that I have read this application and state that the above information is CONSTRU ION LE D[ G CENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a onstructlon lerthing 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.)
toenter 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 ARCHI'I'EC'l"S DI CI ARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 07110/2018 Licensed
Professional