07110093 CITY OF CUPERTINO '� ` ' `
BUILDING DIVISION PERMIT ������������������
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Bl11LDING ADDRESS: PERMIT NO.
10450 PHAR LAP DR WEN KU 07110093 .
., � NER'S NAME: PERMTf LSSUE DATE
WEN KU 10450 P�AR LAP DR � 11/15/2007
PHONE: SAMTARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMTt INFO
BLDG ELECT PLUMB MECH
� � � �
u p p UCENSED CONTRACTOR Deci.nRar�oN Job Description
i� V C I hcrcby aflicm that 1 am liccnscd undcr provisions of CAsptcr 9(commencing
_� wiWSectian7000)ofDivision3ofthcBusincssandProfcssionsCodc �DL BT-IRM� SIDEWL-STUCCO (ONE WALL) UPGRD MN PNL TO
'� y in full force and efkcL
�? Licenx Class �M• � 2 � � AMP
n � Q p Con�racWr
� ARCHI7'ECI'S DECLARATION
� I undcrswnd my plans s6a116c u+cd u public rccords
�yU
4 p � Liccnsed Pmfcssional
y � OWNER-BUILDER DECLARATION
1 hercby at7rtn ihat I sm exempt fmm ihe Conuactars License Law for thc
� p O foilowing rcason. (SecGon 7031.5, Busincss and Profcssions Cak: Any ciiy or county
y^ Pi which rcquires a pcnnit to cnnswc4 a�tcr, improvc, dcmalish, or re�wir any swcturc
prior lo ils issuance, also requircs thc applicanl far such permit to file a signal slalemenl
� s 0 that Nc is liccnscd pursuant to �hc provisions a! thc Conuactor's Liccnsc Law (Chapicr 9 5q. Ft. Floor Area � 5 O O 0 Valuation
y F- �(commencing wiU� Section 7000) of Division 3 of Ihc Business nnd Prof�ssions Cade) or
y �.. that he is exempt Ne�etrom and ihe besis [or We allcgcd eumption. Any violadon of
Secdon 7031.5 by a�ry applicant for a permit subjccu �he applican� w a civil penalty of Number Oceupancy Type
not morc ihan fiw 6undrcd dollars (5500� 3 2 6 3 5 0 4 4!
❑ I. ss owner o[ d�e property. or my employces wiN wages u their solc compensadon,
will do the worlc. snd ihe svuctwe i� not intended or ofleced for sale (Sec. 7044. Husiness Re uired Ins eetions
and Professions Co�: The Conuacwr's License Law does not appiy to an owner of Q p
property who builds or improves �hereon, and who daes such worlc himselt or through hia
owo employces, provided that such improvements ue not imm��d or otfued Cor sale. l[.
however, the building or improvanent is sold within one year of compledon, the owner-
builder will have Ux burdee oC proving Idat he did not build or imprave for purpose of
�+ � sak.
as owner of the pro rty. am acclusively convuting wi�h licensed rnnvactors ta
fonsinut the pmject (Se 7044. Businas and ProCcssions Code:) The Con�ruwr's Li.
ccnse [�w does t spp to an owner of propecty w6o builds ar improves �hneon. �nd ,
who convscts f such jects witL a con tor(s) licensed pursuant to We Convscar's
'-ense Law.
am exem u , B 6e P C for this ressan
�" Owner Date //�
RKER'S COM AT[ON DE RATIO /�/�� ✓� �/1� '`
1 hereby �rtn under penalty ot perjury one of the fotlowing declaruions: �� �/
❑ 1 hsve and will mainlain a Ceni6cate of Conaent to self-insure for Workcc's Compen-
sation, u provided for by Secrion 3700 of the Iabor Code, for the performancc of the �! ��l �
wark for which ihis permit is issucd.
❑ I have and will maintain Workers Compensatian Insurana, u �cquired by Sccrion
3700 oC ehe labor Codc, for thc performance ot the work for which �his permit is issued. � D
My Worker's Compensation Insurancc carticr snd Policy number azc:
Camer. Polity No.: �
CE FICATE OF EXEMPI70N FROM WORKERS'
COMPENSATION 1NSURANCE '
(fhis sccti ucd not bc compictcd if �he permit is for onc hundred dollaza (5100)
or Icu) �
I cenify t in t6 perform c of thc w k for whic Ihis permit i' aucd, I shall not
�, cmploy a perso in any m r so a ec u�u e the�Worl mpensadon
Laws of aii Date
AppGcan
N077CE AM , alcin ihis enificate of Ene ption, you should
bccome s' a thc Wo '� Compcnsation provisions of �hc La6or Codc, you must
� O forthwi�h comply with such provisions or this permit shall bc dccmcd n.wokcd.
z "" CONSIRUCTION LENDING AGENCY
[- � I hcmby aRrtn ihat thae is a conswcdon Icnding agc�y Cor ihc perfarmancc uf ,
Q�., � �he work fur which this pumit is issued (Scc. 309'1. Civ. C.)
W A L.endcr's Namc '
? z Lendec's Address
() 0 I cenify �hat I have resd �his application and stam tha� thc abovc infartnation is
w � cortca 1 agree w com y wiU� alI city and counry ardinances and sute Iaws reladng w
� U building consuuction, d hereby su�horia ceprescntadvcs of Uiis cily to cnur apon Ihc
� W ahove-mcn6oud pro ny (or inspectiao purposea
a (Wc) agree t ve. indcmni(y and kec harmless ihe Ci�y of Cupertino against
H � liabiliti udgmen , oa�s and e:penscs whic m any way acccuc against said City
V z in co uence of ��,��g or mu a���. Date
�"� APPL ANT U STANDS AND WI COMPLY WITH ALL NON-POINT Issued by:
SOU R A ONS.
. Re-roofs
S�gnmum o�nppuca� onuxior ' Type of R �of
HAZARDOUS MATERIALS DISCLOSURE
�II Ihc applicant w futwc building acupant storc or handlc ha•rardous ma�crial
�eGned by the Cupertino Municipal Codc. Ctiaplcr 9.12, and the Hcalih and SaCety
.•_� Scction 25532(a)? All roofs >hall be inspected prior to any roofing material being installed.
❑ Ycs �o
�11 the applicant o r f t\ building accupant usc equipment or cicviccs which If a roof i. � installed without first obtaining an inspection, I agree to remove
cmit ha air coniaminan�s u dcfincd hy �he Bay Area Air Quality Management all new m aterials for inspection.
������
�Ycs �No
1 havc ihe lu�ardous a�cri s icquiremcnu undcr Chap�cr 6.95 of �c Califor-
nia lih & S ty Cadc, Sccuans 2550 , and 25534. I undcrs�and thaz iC ihc building
d not curtc have a ienant, � i' my maponsibiliry W noufy ihc accupant of Ihe
_ req remcn h must be met prior issu of a Ccnificalc of c� �r. S ignature of Appl icant Date
Owncr or authorizcd agcn� � , All roof coverings to be Class "B" or better