The URL can be used to link to this page

04060076 CITY OF CUPERTINO BUILDING DIVISION PERMIT 3RCONTRAC �ORINFORMATION BUILDING ADDRESS: "'U" ND0 4 0 6 0 0 7 6 OWNER'S NAME: PERMIT ISSUE DATE Aft HSUEHHSIA L TANG SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uWU LICENSEDmthatICONTRd TOR under DECLARATION N � Y tl � C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencingco I'uf�' U with 5¢dot 7M))of Division Jof NC Business and Professions Codc.and my license is I.Oluto.mdeffect. ADD 966 SQ. FT. License Class Lica np Da¢ Contractor r L i s< ARCHITECT'S DECLARATION n�l. • Zoo"I I understand my plans shall W used as public records /�� aU Gi Licensed hereby see ,u see e .� S OWNER-BUILDER DECLARATION IgWI�l Yllllll Trott luryl 1 hereby alTrm Nut I oro exempt from dm Contnnor's License Law for the a O fallowing mamn.(Section 7031.5,feminism and Professions Crude:Any city at county K m which requires a permit to construct.alter,improve,demolish,at repair any UMCLUM FIy prior In its issumee.also requires l he applicant for Such permit to file aSlgned Statement < that he is licensed purnuanllnthe provisions ofthe Commeor''SLicense Law(Chapler9 Sq. Ft. Floor Area Va nation ZFp (commencing with Section 11100)of Division 3 of the Business and Professions Code)or y than he is exempt therefrom and the basis for the alleged cscrnption.Any violation of Section 1031.5 by airy applicant for a permit subjects Ne applicant to a civil penalty of 3 61Y8I+Q12]3ber0 0 Occupancy Type not more Nan five hundred dollars($500). ❑I.as Owner of the ptoprrly,a my employees with wages as their sole compensation, will do the work.and the structure is not intended or efficient for sale(Sec.7W.Business and Professions Code:The Commences Liana Law does not apply to an owner Of Required Inspections property,who buildsor imprerms daemon,and who dasm eh work himselfor through his own employees,provided thmsuch improvements as not intended oroRered for sale.If, however,the building or improvement is sold within one year of completion.do Owner- buiider will have the Lurden of proving Run he did not Wild or improve for purpoc of sale.). XI.as owner of the property,am exclusively contracting with licensed contractors to tower the pmjett(Sec.7W,Business and Professions Code)The Contracmr's U- ttnse law docs not apply m an owner of property,who Wilds or improves thereon and who contracts for such projects with u contractor(s)licensed Poffoond to the Contractors License law. I am exTemp/)under sec. .B&P C for this won Owner I�/_ I I — v Date / , f S COMPENSATION DECLARATION 1 hereby affnm under penalty of perjury one of the following declarations: have and will maintain a Certificate ofConsetn to self-insum for Workers Compen- .mn,at provided for by Section 3100 of Ne labor Code.for Ne performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,ns rtyuimtl by Section 31W of the labor Code.for the pdotm eanee of Ne work for which this permit is issued. My Workers Compensation lnw sunncarrier and Policy number ass:: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' , COMPENSATION INSURANCE (lTrs section need not becomplcted if tlae permit is Ramos hundred dollars(5100) or less.) 1 coni fy that in the performance of the work for which this permit is issued.l shall not employ any person in any mortar an U m become subject to the Workers''Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should became subject to the Worker a Compensation provisions of the Ichor Code,you must .,O foMwi0i comply with such provisions or this Permit W deemed mated. z'` CONSTRUCTION LENDING AGENCY I hereby from that them is aconstructim lending agemay for the performance of (� the work for which this permit is issued(Sec.3097.Civ.C.) W Q Land"'a Namc f1 Landers Ad1 U 0 I certify Net 1 have mad this application and sate Net the above information is E' coned I agree to comply with all city and county ordinancesand mute laws relating m QU Wilding conmoction,and hereby authnrin,rtpresancifes of this city to enter upon tha W aawc-mentiorml property for inspecuon purpose& F 11 (We)agree to save,indemnify and keep harmless Nc City of Cupertino against N liabilities,judgments.cam and expenses which may in any way see=against said City U Z APPC of Im Standing of LICANT UNDERSTANDS tSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO R GU TIONS`— I ,fy,n _ Re-roofs _ "cure fApPllL HAZARDOUS MATERIALS DISCLOSURE Data Type of Roof Will the applicam or(more building uccuport stare or handle hamodous material m dcfned by the Cupertino Municipal Code,Chapter 9.12.and Ne Health and Safety 'doicode.Section 25532(a)? yy..'' All roofs shall be inspected prior to any roofing material being installed. ❑Ys 12d rvo Will the applicant or_futuure building Occupant use equipment or dcvices which If a roof is installed without firs[obtaining an inspection,I agree[o remove hazardous air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection. ct? [C�/ ❑Yes $Nu 1 have mal the Waardo-us\materials requirements under Chapter 6.95 of the C difor nla Health&Safety Cook.Seed.25505.25533 and 25534.l undersand Nn if the Wilding does nal rely have a tenant that it u my responsibility noufy the occupant of the mqui pmamt`pgmetpnocwishice faccruf of0.mpaccy. Signature of Applicant Date mon rT l__ l� All roof coverings to be Class"B"or better Owner Or authmimd agent Dao: