11060047 CVtasvr• � -
CITY OF CUPERTINO BUILDING PERMIT)ATE ice—
BUILDING ADDRESS: 854 LILY AVE CONTRACTOR:WEIGANG ZHANG PERMIT NO: 11060047
O ' .R-SNAME: WEIGANGZHANG 854 LI LY AVE DATE ISSUED:08/04/2011
O 'S PHONE: 4088571980 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.q r r r
MECII RESIDENTIAL COMMERCIAL
Contractor Date
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADDITION OP 818 SQFT INCLUDES NEW ATTACHED
(commencing with Sectlnn 7000)of Division 3 of the Business&Professions GARAGE,
Code and that m license is in full force and effect. 2 BEDROOMS,STUDY&LIVING ROOM.REMODEL 13A'rH(145
y SQFf),KII'CHEN(123 SQFT)&EXISTING GARAGE REMODELED
11292011 -REV#1 -FRAMING REVISION-REV#I ISS'D 11/29/2011
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which(his
permit is issued. Sq.Ft Floor Area: Valuation:$128000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35903039.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date Issued by: Date:
All
pij P1 OWNER-BUILDER DECLARATION
Thereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspec(ed prior to any roofing material berg installed.If a root'is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant:_ Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGS TO RE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE,
Compensation,as provided for by Section 3700 of the Labor Code,for the
1 have read the hazardous materiels requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth&Safety Code,Sections 25505,Chapter
and land t I will maintain
Section 3700 of the Labor Code,for the erfomtance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the mateHearial. &
P Safely Code,Section 25532(a)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of Me work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Ouahty Management District I will
not employ any person in my manner so as to become Subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making Ibis certificate of exemption,1 Ilealth&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
Owner,or authonzcJ nl x -,h,�,,� I h', -.
forthwith comply with such provisions or this permit shall be deemed revoked. 4 J `--�� Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building conslfuclion,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned properly for inspection purposes.(We)agree to save Lender's Name
jftndy,and keep harmless the Cily of Cupertino against liabilities,judgments,
nd expenses which may accrue against said City in consequence of the Lender's Address
g of this permit.Additionally,the applicant understands and will comply
with all uoll-point source regulntiams per the Cupertino Municipal Code,Sectiat ARCIIITF -S DFCLARA-TION
9,18.
i'- I understand my plans shall be used as pail is records.
Slg nature �'�c�.-. - ". 'Date Z�
License)Professional_
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 854 LILY AVE CONTRACTOR:WEIGANG ZHANG PERMIT NO: 11060047
OWNER'S NAME: WEIGANG ZHANG 854 LILY AVE DATE ISSUED:08/04/2011
C 'R'S PHONE: 4088571980 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATIONr
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADDITION OF 818 SQFT INCLUDES NEW ATTACHED
(commencing with Section 7000)of Division 3 of the Business&Professions GARAGE,
Code and that my license is in full force and effect. 2 BEDROOMS,STUDY&LIVING ROOM.REMODEL BATH(145
SQFT),KITCHF.N(123 SQFT)&EXISTING GARAGE REMODELED
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$128000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35903039.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date /
g Issued by: � Date:
i OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material berg installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for tine
performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,2.5533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
Owner or autho—�
r•ed-agent:
forthwith comply with such provisions or this permit shall be deemed revoked. —
^..�" Date:-
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of V�Ork's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
c—'s,and expenses which may accrue against said City in consequence of the Lender's Address
ng of this permit.Additionally,the applicant understands and will comply
ill non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
_ 1 understand my plans shall be used as public records.
Signature` ' "-Date oio4611
Licensed Professional