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B-2019-1088BUILDING 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: 4089166777 CONTRACTOR: OWNER - BUILDER CONTRACTOR PHONE: DATE ISSUED 11/12/2019 1:47:26 PM ISSUED BY: HALEYM VALUATION: $6500 JOB DESCRIPTION REPLACE SIDING LIKE FOR LIKE (960 SF) OWNER -BUILDER DECLARATION I hereby affirm under penatly of perjury one of the following two declarations: I, as owner of the property, or my employees with wages as their role compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professions Code). V I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business & Professions Code). I hereby affirm under penatiy of perjury one of the following two declarations: 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. 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. V I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municioal Code. Chatter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. An EPA Lead -Safe Certified Renovator will be responsible for this project. Certified Firm Name: Firm Certification No: V No EPA Lead -Safe Certified Firm is required for this project. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code). �Yes No Lender's Name: Lender's Address: APPLICATION 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 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, judgements, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municioal Code. Section 9.18. Signature: .