03020093 CITY OF CUPERTINOa.^ ��
BUILDING DIVISION PERMIT COO N1'RACTOR INFORMATJON:
BUILDING ADDRESS: PERMIT NO03020093
1 '11 TWTr TIM
R'S NAME: PERMIT MUE DATE
SHONG WANG
.HONE:
SANITARY N0. CONTROL NO.
ARCHITECTIENCINEER:
,BUILDING PERMIT INFO
` BLDG ELECT PLUMB MF.CH
0 0 0 0
.00C LICENSED CONTRACTOR'S DECLARATION
!UI hereby a(ftrm that I am licensed under previsions of Chapter 9(commencing Job Description
with Section 7")of Division 3 of be Business and Profession..,Cndc.and in,license is
iq? Licenlso CluenticffecL Lic.N SFDWL—LIVING SPACE 3, 611 -
;moo Dam usedaspu GARAGE 498 SQ FT. FINALED
44 ARCHITECTS DECLARATION
i C i I underhand my Plans shall W used az public rccnrds
)yU
�oH Licensed Professional
S OWNER BUILDER DECLARATION /"c"��
<q 1 hereby affirm that I am exempt from the Contractors License Law(or the NOV '-/ 2004
p o following reason.(Section 703 I.S.Business and Professions Code:Any city nr county
5_ which requires a Permit m construct,eller.improve,dencidsh.or Opti,any structure
-zo poor to its issuance,also inquires the applicant for such Permit to file a signed statement
< that he is licensed pursuant m the previsions of the Contractors License Lsw(Chapter 9 Sq.Ft.Floor Area tion
,lion (commencing wi th Section 7000)of Division 3 of the Business and Professions Code)or
Met he is exempt thcmfrom and the basis for be alleged exemption.Any violation of 1 O 9 O O
Section 9031.5 by any applicant far a permit subjecut the applicant to a civil Penalty of APN Number Occupancy Type
not more Nan five hundred delta.(5500). 37508018 . 00
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do be work,and the struauO is oat intended oroffefed for sale(Sec.7046,Business
and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections
property who builds or improves bemon,and who does such work himselfor through his
own employees,provided that men improvements are not intended or offered for able.If. 101 - FOUNDATION
however,be building or Improvement is sold within one year ofcompletion.due owner-
buileer will have Ne burden of proving that he did not Wild or improve for purpose of 102 - PIERS
Sale')' 103 - UFER
®,1,as owner of the property,am exclusively connecting with licensed contractors to 10 4 - REBAR
construct the project(Sec.7044la
,Business and Professions Code:)The Conctor's Li
u law does not apply m an owner of pmperty who builds or improves thereon.and 105 — ANCHOR BOLTS
who contracts for such projects with a contractors)licensed pursuant o the Continuities
License Law. 106 - SEWER & WATER
❑I tmexerepl undo sec. B&P C for this Mason 202 - UNDERFLOOR PLUMBING
ODa ''/ b3 - UNDERFLOOR MECHANICAL
WOKRERTCOMPFNSATION DEC; AIT N 203
- I hereby atfum under penalty of perjury one of the following declarations: 204 — UNDERFLOOR FRAME
❑I have and will maintain a Cenificate of ConsenuoseB.insuO mrworkers Cumpcn, 205 — UNDERFLOOR INSULATION
Station,as provided for by Section 3700 of the labor Code,for be performance of the 301 - ROUGH PLUMBING
work Nr which his .it is issued. 302 - TUB & OR SHOWER
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 ofbc labor Code,for the Performance of the work for which this permit is issued. 303 - ROUGH MECHANICAL
My Worker's Compensation Insurance carrier and Policy number am: 304 - ROUGH ELECTRICAL
Carrier: Policy Ni 305 — FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 - HOLDOWNS
(Thissectinn need not be completed if the Permit is for one hundred dollars(SIM) 307 - INSULATION .
Ilea,.) 308 - SHEETROCK
employ certify thin or the performancers the work for which bis permit is issued,I eha11 nut
Lawson California.oninanymanncrsnasmWcomesubjelmbeworkers'Cnmpcnsation 309 — EXTERIOR LATH
Laws of carroDa"
Applicant 310 - INTERIOR LATH
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 311 - SCRATCH COAT
become subject to the Worker's Compensation provisions of be tabor Code,you must
0z Forthwith comply with Rich pmvisima,orthis No.ilShot Mdecmeamwked. 313 - ROOF NAIL
zC CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
t-t ice+ 1berebyinpiondoudoreis.constructionlendingagencyIortheperformanceof 502 - FINAL PLUMBING ENERGY
Cli be work for which this Permit is issued(Sec.3097,Civ.C.)
W O Under,Name 503 - FINAL MECHANICAL ENERGY
� Z neeraAearca 504 - FINAL BUILDING ENERGY
U0 I certify that I have read this application and slam that the above information is 505 - FINAL ELECTRICAL
correct.I agree to comply with all city and county ordinances and state laws Mlating m
Dplm�U building conswction,and hembyoutho,iaerepresenmtivesofthis city toenter Upon the GAS EST
Uvompe
aboentioned pmrty for irupeetion purposes.
(We)agree to arc,indemnify and keep harmless the City of Cupertino ag.inal 07 FI
fF V) liabilitinjudgmen¢,costs and expenses which may in any way accrue against said City 5 ICAL
U z in Consequence of the granting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
SOURCE REGULAMO
/4�
463 Re-roofs 5 4 - INAL PUBLIC WORKS
St um Appbcan onuamor em
1 HAZARDOUS MATERIALS DISCLOSURE Type ofRj2 _ ROOF PLYWOOD NAIL
Will be applicant m future building oceupam stere or handle haardous material
di Fined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety 603 - ROOF BATTENS
.Seebea 25532(a)7
❑tics {{No All roofs sb4lgbe insNgtq#ri?Ntojap g�Flg Elaterial being installed.
Will the anPlman or future building Ienpanl t equipment m device.,which If a roof is installed without first obtaining an inspection,I agree to remove
emit havandous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ®Nu
I have read the hazardous materials Mquimmenn under Chapter 695.f be Cali for
iia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that ifthe building
does not currently have a(them,bat it is my responsibility m nod I the occupant of the
requiM biers mctpsiohrissuenccofaCenlfea Occupancy. Signature Of Applicant Date
�(� All roof coverings to be Class "B"or better
OM or authorized agent Dam