05070061z C
a>_
Lk, C
UC
UC
0E
6
Uz
CITY OF CUPERTINO
A " �;' •`
BUILDING DIVISION PERMIT
CONT"; C, T, IR TNP'ORMA'CION:�°
' .i' 0 . .f ':''. ✓".kAih a iL F.. fi'
BUILDING ADDRESS:
10370 STERN AVE
WEI JENG
PERMIT NO. 05070061
NAME:
PERMIT L95UE DATE
FwER's
WEI JENG
10106/2005
PHONE:
SANITARY NO. CONTROL NO.
ARCHIlECTIENGiNEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� LS 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
- P
1 Mmby affirm Net 1 Am liecand under Provision of Chapter 9 foammemting
with Secdon 7") of Division 3 ofthe Business and Profeasluas Cade, and my It.—u
I. fell font andefraL
ADDITION 1,304 3 BEDRM/3-1/2 BATHS -2ND STORY
License claas Lk'a
Dam Contractor
ADD 3561GARAGE/REMODEL BEDRM/KITCHEN
ARCHITECTS DECLARATION
ROOM/DINING
1 understand my plans shall W used As public recordsFAMILY
Licensed PN(nalo al
OWNER -BUILDER DECLARATION
I herebysin. that 1 am exempt from the Conlractar's License Law for the
following moon. (Section M3 1.5, Business and Profession Code: Any city or roomy
which requires a Permit an come act. alcor, Improve, demolish, Is, A pear any sWctum
prior of its [nuance, alae requimnW applicant for such permit to Ole a signed summem
Contractor's Umnse Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed personal to the provisions of the
(commencing with Section TDIID) M Division 3 of the Business And Professions Code) or
$299609
that he is attempt therefrom and the basis for the alleged aemptlan. Any violation of
APN Number Occupancy Type
Section 7031.5 by any applicant for A Permll mbjeeta the applicant to A civil penally of
not atom than five hundred dollars ($300).
❑ I'm owner of the property, or my mnploym with wages As their sale compensation,
will de the work, and thesuuctu , is notmmtwed At offered forasie(Sec. 7044, Business
Required Inspections
et
and Professiaa Cade: The Committees License Law don troapply N an owner of
q P
property who Wilds mirepr.ves Nermn,and who doeaamhwahhimmlfor through his
own employees, provided that such impmwmenw am not Intended oraffered foram, IL
however, the building or imprevemenl is mid within one Sem of completion. The owner-
builem will love the burden of proving that M did not Wild or improve far purpose of
asmJ.
1. a owner of the pmpeny, am exclusively contracting with licensed contractors m
w ,ract tite project (Sec. 7044, Business and Prefenoru Cade:) The Contnctoh Li-
cense Law den not apply to an owner of property who Wads or improws thercon. md,
who margins, far such projects with A contractor(s) licensed pursuant to tae Conlrmwfs
License law.
❑tem sept under See . B k P C far this ream.
Date _(V6 0
WORKERS COMPENSATION DECLARATION
1 hcmhy of irse under penally of perjury am of me following declatation
I ban and will maintain a Ceraficate of CONenl to self-lasum fa Worlmeseampen.
smion, a provided On by Section 3700 of tee labor Code, fm the performance of the
work for which this Permit is finned.
❑ 1 haw arta will maintain Worker's Compensation Insurance, as required by Section
3700 of the latter Code, for the performance at the work for which this permit is tawed.
My Wmime. Compensation Insu. artier and Palley number Am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed Bthe Permit Is for onehumbed dollars (5100)
or las)
1 certify that in the parte m once of the work for which this Permit Is Issued, I shell not
m la an rmnmm mmnrmas mbac aWk CII t WprkCra'L'am .anon
M
of orni�.
Laws Cah Ie `� /Fs v L
Applicant s A 161Td'
NOTICE TO APPLICANT: If. after mhing NE ni0cate of Exemption, you should
become subject to the Workeh Compensation provisions of Ne Labm Code, you must
forthwith comply with men provision or this permit shall be deemed conked.
CONSTRUCTION LENDING AGENCY
I Mmby affirm that them Is a construction tending agency for the performance of
the work for which this permit is Island (Sec. 3097, Civ. C.)
Undoes Name
LeamelAdmae
.
I mnlfy that I haw need this Application and state that the show Integration is
Gane. I agree to Comply with all city and County onfinances and state lama mining; to
Wilding construction. and hereby mlbodse representatives of this city to enter upon the
aWw-mentioned pmpcny Our impoNoa purposes
(We) agme to ssw, indemnify and keep harmleas the City of Cupmim against
j liabilities, jWgmcnu, can and expenses which may in my way arm Main said Cityin
i APPLICANTLUNDEof me RSTANDS ANof this D WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGU
/O5
e�
Re -roofs
Type of Roof
—[IW
`•I O/
Sig num Ol'AppliciMACOntractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the aPPIIC.L sir future Wilding =up., non or handle haardoa material
As defined by the Cupertino Municipal Cade. Chapter 9.12, and the Health and Safely
. Section 25532()7
All roofs shall be inspected prior to any roofing material being installed.
❑Ya NNu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future occupant m devises which
ea
nus it contaminants m deOncJ by the Bay Area Air Quality Management
AMR dcnacd y A Air Quality
all new materials for inspection.
District?
DlmicG
❑Yes �Nu
I heves mad the hmardousmaterialsmquimmcnta under Chapmr 6,95of the Califor.
nix Heolth,k Safely Codo,Sec0on25SO5,23333 and 25534,1 understand thatlf the Wilding
dna not currently haw a tenant, that It Is my map ralbility m nosey me =upset a(the
requimm is which mug bemelOur enlnaleofOcaputey.
Signature of Applicant Date
Lo (0
All roof coverings to be Class "B" or better
Owner m mNarimtl egcnl Data