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L7 0 U3 CL Q LL U U U OLc a> CFFY OF CUPERTINO :: Wz BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10475 BEARDON DR T & R MANAGEMENT & 08050078 OWNER'S NAME: PERMIT ISSUE DATE TZEKING ROCKY CHAN 6172 BOLLINGER RD STE 151 07/07/2008 PHONE: SANITARY NO. CONTROL NO. (408) 329-2831 ARCHIECT/ENGiNEE3L BUILDING PERMIT INFO BLDG ELECr PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description Z1_9 I hereby aRrm that I ow eSiI licensed under provisions of Chapter 9(commencing P z� with Section 7000)of Division 3 of dw Budrrm and Professions Codeand my license is S FDW L DEMO A. in fun force and affect. jz''...License Class Lic.0 Dam Contract" 3 ARCHITECTS DECLARATION 1 understand my plans shall be used as public records t CJ Licensed Profcssionel OWNER-BUILDER DECLARATION �g1> I hereby affirm that 1 am exempt from the Contractees License Law for the y q 'following mason(Section 7031.5.Badness and Professions Code:Any city or county which requires a permit to coollnCt.alcor,improve.demolish,or repair my structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement _ the he islicensed pursuant to the provision&of the Conuncmr's License Law(Chapter 9 Sq.Ft.Floor Area Valuation H, (Commencing with Section 7000)of Division 3 of the Business and Professions Code)or $12000 y that he Is exempt thenlrom and the basis for the alleged exemption.Any violation of Section 7031.5 by sty applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type ria niece thin five tivadred dollm(&=o 32630152 ❑L as owner of the propety,or my employees with wages as their sole compensation, will du the wort.and the atoxtur t is not intended or offered for sale(Sox 7044,Business and Profession Code:The Contractor's License Law does rot apply to an owner of Required Inspections property who builds orimproves thereon,and who does such work himself or through his two employee provided dot such improvements are not intended oroffered for sale.If. however.the building or improvement 4 sold within one year of completion.the owner- builder will have the bee I of proving that he did tat 6did or improve for purpose of UL-Q. L as owner of the property,am exclusively contracting with He meed contractors to odlumuct the project(Sec 7044.Budnra and Professions Code:)The Contractors U crone Law does tot appy to an owner of property who builds or improves thereon.and who contracts fa such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Six .B&P C for this mason Owner 7� eNl W COMPENSATION DECLARATION I hereby alum under penalty of perjury ane of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for water's Compen- ration,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 requited by Section 3700 of the Labor Code,for the performance of the worst for which this permit 4 issued. ' My Worker's Compensation Insurance artier and Policy number art: Cartier: Policy No.: CEKIFICATE OF EXEMPION FROM WORKERS COMPENSATION INSURANCE Mtis,uetion need not be completed if the permit is fa one hundred donna(SleD) or less.) I certify that in the performance of the work for which this permit Is Issued.1 shall not employ any person in any maoncr so i ect to the Worlmrs'Compensation L,ws of California.Dae Js Applicant NOTICE TO APPLICANT:ff.after making Lift cadfiale of Exemption,you should become subject to the Workces Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be donned revoked z OCONSTRUCTION LENDING AGENCY C'n I hereby affirm the dim is a construction lending agency for the performance of 1 > dle work for which this permit is issued(Sex.3097,Civ.C) QLenders Name =z Lender's Address J Q 1 certify that 1 have read this application and sum that the above information is .. correct.I agree to comply with all city and cotmty ordinances and stale laws relating to building construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection pros pose (We)agree to save,indemnify and 1mcp harmless the City of Cupertino against Hto liabilities.judgmcon.touts and expenses which may in Ary way accrue against said City in cansequeace of the granting of this permit. r1- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ��7 SOURCE REGULATIONS. 14/0 ` / Re-roofs Signalum of ApplicaffliConLractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof WI11 the applicant or future building occupant store or handle hnardous material as defined by the Cupertino Municipal Code.Chapter 9.17,and the Health and Safety Code.Section s 25s3z(a)? �Na C]Yes All roofs shall be inspected prior to any roofing material being installed. oris the applicant or future building occupant use equipment or&vices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants n defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ,cNo 1 have read the hazardous materials requirements under chapter 6.95 of t e Califor- nia Health&Safety Code.Sections;25505,25533 and 75534.1 understand tut if the building does not currently have a renaq that It's my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Cerdrnam of Occupancy. Signature of Applicant Date Owner Of alithoriMsCijgral. Date y /o All roof coverings to be Class'91?'or better D dkvs o07.f CITY OF CUPERTINO ' DEMO CUPE�FINO PERMIT APPLICATION FORM APN# � 3 O � � � . v a Date: Building Address: j 0 4 3� &6trd e-A Ori IA? Mailing Address (if different from building address): /�/ 5a t# Owner's Name: Phone: TzEk11v67 ci-/AA JL4 - 31k - 3v-pd Contractor: Phone TB D Fax: Contractor License #: Cupertino Business License #: Contact: TZ&K/N C �-/A-A/ Phone: Fax: ( ooh Residential ® Sq Footage 3` Commercial ❑ Sq Footage Job Description: Valuation: I r 0 Please complete relevant portions of the Green Building Checklist & attach it to the a 'on or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type r 1DEMORES Demo-Residential B 1SFDWL-DEM / 1BSEISMICRE Seismic Residential B f 1DEMOCOM Demo-Commercial B 1COMML-DEM 1BSEISMICOM Seismic Commercial B 1BUSLIC Business License B Community Development 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: j D f--�5 goa Or,'v-e. PERMIT # C 0 0'7,f OWNER'S NAME: Tz&K iN c, c mV PHONE # D ' — 3 I -3 vJ GENERAL CONTRACTOR: 7-60 FAX# Tg p I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile SUS O�Wer/ Signature Date