06040061gFC
CITY OF CUPERTINO
74 —7"
CONTRACTQ,,RINFORMATIQN
BUILDING'DIVISION PERMIT
BUILDING ADDRESS:
JACK CHANG CONSTRUCTION
PERMrr'06040061
10370 STERN AVE
OWNER'S NAME:
PERMOT ISSUE DATE
BHUAN-MIN CHANG
10220 STERLING BL
2006
-
SANITARY NO. CONTROL NO.
(408)517-8878
ARCHI'IECI'yENO1NEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSEDOatIAm ONTRd S DECLARATION
Job Descrlp
of CON
under provisions of Chapur 9 (commencing
1 thu 1 am under
Bu
with Section ]IXX)) of Division ] of the Businets and Professions Cade. AM my license u
ionbercloy70 0) of Of the
in full forts and effecL C-�
47 le
DEMO OF ONE STORY SINGLE FAMIL
Lieen Cl uns .R
Date {-lr-ra (I- Com em' '
II
Jut
ARCHITECTS DECLA TI
c
III �oou
1 understand my plans shall k used an public mcoM
a ))) 6
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm Nat I am exempt from the Contractors License Law for the
/gg
following mason. (Section 7031.5. Business And Professions Calc: My city or county
which mquiros a permit to Cinnamon, alter, improve, demolish, or repair any structure
x/,IQ 00
prior m its issuanco, a)u mquius the applicant forsuch pmetit m Blc a signcd sidemen,
Out W is licensed pumant to the pnedions of the Contractor's I-conce"Ar Chapttt9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Prafessions Conic) or
Oat he is exempt therefrom and the huts for the alleged exemption. Any violation of
Occupancy Type
Schon 7031.5 by arty applicant for a permit subjects this applicant to a civil penalty of
net moo Nan hw bandied dollva (SHOO}
,
0 1, As owner of On Property, or my wploycm with wages u their tits compensation,
Required Inspections
will do the work and thes=nort is not imanded or Offered for sale site. 7044. Business
end Professions Code: The Contractors License Law dors not apply b an owner of
q P
property who Wilds or im pravu thereon. and who dostsuch work himself or through his
awn employees. provided that such imp ro ins mson in art not inmrlded oroRered for sale If.
however. Ne building or imprownsent u sold with. one year of oaupktlon, the owner -
builder will have Ne burden of praying Nat he did not Wild or improw for purpose of
sat.).
0 1, as Owner of the prapeny, am exclusively contracting with licensed convectors in
construct the project (Sec. 7044, Business and Pro4suans Cade:) The Contractors U.
cense Law dao not apply b an owner Of property who Wilds Or Improws thercon. And.
who contracts for such projects with a anhamr(s) licensed pursuant to the Contractors
Licenme Law.
O lamexemptuMursec. ,B&PCforthis..
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 be eby afBmt under penalty of perjury ane of the following doelaruions:
.
1 h: -am will unuin a CenfiConsentm se
ite of Consent self -insure fee Workers Compete.scion,
u pmvidcd for by Section 3700 of the Labor Code, for On perfomunce of the
work for which this permit is issued.
0 1 haw and will maintain Worker's Compcmauan Insurance. as renuirod by Section
37M of the labor Code, for Ne performance of Ne work for which this permit Is issued.
'
My Workers Compensation Wumnce artier and Policy number art:
Carrier. Policy No.:
C ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This xttion need not kcompleud iftic permit in fortune, hundred dollen(5100)
r
or Icer)
I anify Out in the paromunce of the wart for which this Permit u issued. I shall not
cm Pl.yan3'Pen In My mMlcrsa al in Won. subjectutk WOrkcri Compcmation
Isws of Cal(fO7-"Om
-" Il
. APPliant r
UdAN��—
abouli
NOTICE L)CAIfT!ar"C-term la s cmBif
oFLabor
Worker's Co.. a Csyou
pmvit iapf Ne Labor Cade, you mlm
9f .youraw
kcome ahicelcomp
y it
' foMwiN comply with such provisions or Nu permit s�c deemed coveted.
this
i
i CONSON LENDING AGENCY
I kr by Old them uaco
em isac agency for she Performance of
which
Ne work for which thu permit is issued (Sec. JW7, Civ. CJ
(Sec. 097, Cit,
i Name
Under's
Lenders Address
'
j 1 ceniry Nat I have read this application and sum Nat the abow information is
'
' conctt I agree an comply with all city and county ordinances and sum laws relating m
building construction, and hereby mlbome mprescacadws of this city to enter upon Ne,
shove-mcmioncdnm.co for! purposes.
(We,) agree to now. indemnify and kap harmless the City of Cuperuim agairm
j liabilities, judgments. caste aM cxpenus which may in any wyattme agaimtsaid City
capitation;
m conuquc a 01 Ne granting Of this Permit.
' APPUC UNDERSTANDS AND WILL MPLY WITH ALL NON -POINT
_
Issued by: Date
SOU C EGULATIONS.
Re -roofs --
Type of Roof
Z °
u a Appiman or Date
HAZARDOUS MATERIALS DIS URE
Will the applicant or forum Wilding acupanum r handle hacirdous matenal
let
-
u defired by the Cuperdna Municipal Cade. Chapur the Health and Safety
Code. Section 25532(a)T I
CYca ' Pt40
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment an di which
If a roof is installed without first obtaining an inspection, I agree to remove
t honrdom air contaminants At thfood by the Bay Area Air Quality Management
all new materials for inspection.
Disvict7
0Ym Odd
.
1 have read the huasdnm me ials rcquimments underChapter 6.95oftheCalifor-
my Seetiom 25505,25573 and 25534.1 undersuM thss irNe Wilding
nuHea9.�.hwh.m1WdAmpmlr
dam nounapt, Nat itis my res on.W Why m many the occupant Of the
re, missu ofacamramoraetupy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
ncrmDau'