06010057 (4) CITY OF CUPERTINO ?
PERMIT 'TR CTtYU�ttRozTENsTBUILDING DIVISION 0
ATIP R
BUILDING ADDRESS: UNIQ ELECTRIC INC PERMRND'06010057
716 rQT1T.TNrqWQRTl4 RT
ER'S NAME: PERMIT ISSUE DATE
SHUNG-FU SU 3248 MORRI 2006
INE: SANITARY NO. CONTROL NO.
(650) 773-3734
ARCHITECTIENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o t� 'tom
�oo LICENSED CONTRACOWS DECLARATION Job Description
re I hereby affirm that 1 am licensed under Drmi,iom of Chapter 9(commencing p
n� with Section 701)(1)of Dividon 3 of the Business and Proftss)om Code,and my license is
In full force and affect. ADD RECESS LITE/REPLACE 6 CEILING LITE
Lkan¢elass Lie.j
Date Contactor ADD DEDICATED CIRCUIT FOR MICRO
e ARCHITECTS DECLARATION
y 1 undcaunJ my plata shall M used an public rccnr0
�c Licensed PntTesaionaf
3 Met I am exempt fr DECLARATION
Z O y 1 hereby.(Irm on 1 em exempt from the test..Co License)sit for Ibe
4 o o following reason.(Saito 8131.5.Business and wc.do oli Cade:Any city or county
.x$� which agates•permit m cnrtstntc4 alter,improve,dcmoluh.or repair any structure
4;i prim to its issuance.elan requima the applicant for Inch permit to rile a signed statement
a Nethcislicensed Famous tothe provision ofMeCommus',UtenseLaw(Chapter 9 Sq. F[. Floor Area Valuati�p�000
FCS (commencing with Section 70W)of Division 3 of the Budnccand Professions Code)or
3.. Nat he is exempt therefrom and the basis for the alleged eaemplim.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant in a civil penalty of APN Number Occupancy
but more than Iva hundred dollms(1300). 35617051 . 00
p y��
❑1,as awntt of Ne property.m my employcta with wages u Heir sole compewOm, Q
will do the work,and Neatmctum is not intended or offered for salt(Sm.7044,Businesss
and Pmrommut Cade:The Contractor's Ligase Law doss cot apply lo an owner of Required I picflow/
property who builds or improves thereon,and who does such work himsel f or through his
own employers,provided dwsuch Impmwmenta w not intended reoffered forule ff.
hownwo.the building or imp owmem Is sold within can letter places.the ower.
builder will Mw the burden of proving that be did not build or imprew for purpose of �'^� 'I H
ask.). r? +t
❑L as owner of the progeny..Business sivnd convecting Cwithod:)TheeC wnuutoa .
come a the project(Sec.70x4,wnerofand Prony.who as Cade:) prows thertm, IBIWf gl)77 t(,n)� (f�
cause Law crus not apply je ts wither of propeny.whw sdWild,or ant invn thereon,and, (❑(j{
who contracts for such projects with a contractor(s)lcensd pursuant m the Contractees
License am Law.
0 I am exempt undo Sec. .B d P C far thh moon '
'at
Date
WORKERS COMPENSAT70DECLAR
N ATION
1 hereby aflm under penalty of perjury ane of the following declarations:
I haw and will maintain•CeNfiate of Consent m xlM1lnsum for WarksYs Compen.
near,u provided for by Section 3700 of the Inbar Code,fm the performance of Ne
work for which this permit is load.
❑1 haw and will maintain Warker's ComperuNm Immranco,as required by Section
37W of the Labor Code.for that performance of the work for which this permit Is luted.
My Warkeh Compensation Makeramm carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' '
. COMPENSATION INSURANCE
(This acedm need cot be comp k ted if the permit Is fm ane hundred dollars(SIM)
re less.)
I sonify Not in the performance of the work for which this Permit is Issued,I Nall no,
employ.eyperecomanymmnerw l beams mbjecttt tie Workers'Compemnim
Law.of Ceiifomla.Qgte cal/las o
Applicant L G� "7
NOTICE TO APPLICANT:If,after making this Cerurtilhis of Exemption,you should
became subject to the Worker's Compensation provisions of the LMor Cods,you must
.,O forthwith comply with Inch provisions or this Permit shall N deemed cooked.
Z" CONSTRUCTION
(•'�N+ LENDING AGE
NCY
I hereby aff.Nat thea B a construction ending agency
for the performance of
C:ti
the work for which this permit ta tasncd(Sec.3099,Civ,C.)
Q LelMeh Name
n7. z Isndeh Address
U0 1 cenify that I haw read Nie application and ate that the above information i,
UL.F mrtecL 1 agree in comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authorlm representatives of this city to enter upon the
W ahovamenticned property for impaction purposes.
G (We)agree to saw,indemnify and keep harmless the City of Cupertino against
% liabilities,judgments,casts and expenses which may in any soy accuse against aid City
U x in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL CO LY WITH ALL NON-POINT Issued by: Date
SOURCE REGULAT obib.
Signature of Appliemucmwctm z Data Re-roofs
HAZARDOUS MATERIALS DISCLOSIQ Type of Roof .
Will the appliantor future building aecuptatisom orhandle husrdous material
as derined by the Cupertino Municipal Codc.Chapter 9.13.and the Hulth and Safety
Section 253734)?
[3 Y. eNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvicta which If a roof is installed without first obtaining an inspection,I agree to remove
it hammnus air contaminants as defined by the Bay Ara Air Quality Management all new materials for inspection.
Diwiet7 J
❑Ye. Op Nu
I have read the havardous materhk requirement under Chapter 6,93 of the Cablar-
nu Hal&SafayCodc,Sm4ms 25303.21333 and 25334,1 ancientness that crenif de building
data not currently haw a tenant,thus it u my responsibilite IQy m redly the a<upset of de
requimmenta ichmuybcmetprimue , I CcniOateo(m CY Signature of Applicant 'Date
OwO,rorauthmimd..ggent Date All roof coverings to be Class"B"or better