08030062 CITY OF CUPERTINO
BUILDING DIVISION PERyU1C4QL`sjF `�+�+•' �j
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Tb%'9 l"5AVISON AVE MICHAEL SHINING P`M5 8062
NlER''1S NAME: lJ FERNI TLSUEDA]E
YONGZHONG LI & ZHONGYING CHEN 34140 ALTDREY CT - 04/08/2008
PHONE' (510) 791-1588 SANITARY NO. CONTROL NO.
"';H"ECT/ENGINEER: BUILDING PERM"INFO
BLDG ELECT PLUMB MECH
l� t o l�
sop LICENSED CONTRACTORS DECLARATION Job Description
4�F Iion7 )of Divatlamfthe ed Business
and Prolmons of Chapter day license
REVISION, ADD I RM; ORIG #07-100112 NO NEW PERMIT.
Mw wit Section 7") Dlvioon3mf the Budneu and Profeuions Code,end mylicenm is
in full eMtt and effect
OORnm CClassLle.or
DOOR.Contractor
ARCHITECTS DECLARATION
understand undernJ my plans shall he used u public rtrnrt
�yU
gird Named Prober el -
b OWNER-BUILDER DECLARATION
atm
sz 0 9 I Wrthy.(firm that 11. exempt from the Cscion,Co LkenSa Lew for dm
O O following moon.(Section IIDLS,Business and Rai.&MI Code:Any riy s roomy
S$ which mquima a pormit sum re �ct LI l shar.nNiC imProw,demo',W,fie A lir any atmmum
priMmiu lensed omatORithe provision of for such ontracnilwriense, RRA Law(Cha mens
E�O thatWWicanacd punvant tothe pmviaiunsaf One
se Boxmr Rod
law(Chapmr9 Sq.Ft.Floor Area d� Valuation
g (cam a is ing exempt
Sectiumform and)the
Wig
3.1'tM B ed cro nO on.Any
Cade)of +'O
r3— uratic ts esuopt thaefrom and Ne buts Lot the ccs Obc eumptiam Any riolWon of
Suction than five
an)'med doll s for.permit subjects the epplleuuo a dvil penslry of 36926034 .AWNumber Occupancy Type
eros moa than Rw hundred dollen(SS1104
❑I.Saawsv ofth pmpcny,mmy wployce with wgau the'v sale rompewdan,
will do thewodc and the wrocumn ts OR inmttdedar offered forsale(Soc.'/ON,BWneu Required Inspections
Nd ProfeWoea Cade:The Canoacto's License Law d.net apply m e an owner of q p
property who Wilda M improves thereon.and who does such work himaelfor dueugh his
Own employ=,provided that such improvements are not intended Or offered for Sale.If.
however,lie building or Improvement Is Gold within ons year of completion,the Owner.
builder will haw the burden of proving that M did net build or Improve for purpose of
1,a owner of the property,em esduiv<ly conuscdn6 with licensed contractors to
ed wct the project(Sec.]Ms.,Business and Professions Cade:)The Contractor',LI-
censa law does not apply to in owner of property v the
Y who Wilds or improreon.and,
who contracts for such projects wit a commomr(s)licensed postero to the Contractors
Lleense Law.
❑
1..xempt un B h P C for On.rc
eon '
Mr 'f0 Dam
�WORKERN COMPENSATION DECLARATION
I lmroby a1Ron under per dy of perjury one,of the following decan6ons:
❑1 haw and WII msinuin s CeniOam of Conserv to self-insure far WorkeraCmmpeo- '
wort
work for
provided far Saction 3]00 of dm IaWr Code,fm W performanim of the
fwhich this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3700of to Labor Code,for the pufarmsnce ofthe wok for which this permit is issued '
My Wmksrs Compensation Won.carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF MEMP 70N FROM WORKERS'
COMPENSATION INSURANCE
(This sceahm need Out W completed if to permit is furore hundred doll.(Sid)
M less.)
I certify that In the performance of the work for which this permit Is Issued.l shall not
employ any Pcraon in Say manner sou to became subject to the Werkep�Cymrenion
Laws of califomia.Date j/L/��6
Applicant L� = -
NOTCE TO APPLICANT: after m I l eniricam or Exemption,you should
became subject to the Workers Compcwtlon provisions of the Labor Code,you most
,J O forthwith comply with such provision or this Permit tail be deemed¢naked.
Erat CONSTRUCTION LENDING AGENCY
[-�� I hereby affirm Ron Vert is a ronstroWnn lending agency far dna performable of
C/. the wort for which this Femur l named(Sec 3097,Civ.C)
QLanders Name
z Lenders Address
U O I Miry that 1 have.ad ria appfiaWon and show dna the above iMatmWM l
U.E cmrtn.l agree to comply with all city ad county ordinuues and rude law resting w
� SVWilding convection,snl Wrtby autodm mpexnutivea of this city OR rnmr upon de
W above-mentioned pmNny for inspection purposes.
py (We)agree to Saw,indemnify and keep humlw the City of Cupertino against _
liabilities.judgments.costs and eapmses which may to any nay accrue against said City -
in
Of Lhc
MORS Of
U
APPLICANT NDERSTANDS ANDWILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU0.CE REGULATIONS. n V/#/J_K
( ` Re-roofs
Signalurtof Appli d antractoOam
NA2ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the eCuputof futurebuildingCode.
Chaptuomm handle Health anmuerial
u deRxd io the Cupertino Municipal Code.Chapter 9.11.and the Health uJ Safety
.
Section 23332(.)7 �a All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit huaNnus air oMtuninIDb as defined by the Bay Amo Air QuWty Management all new materials for inspection.
District?
❑Yoe gNo
I have mad the hviNouamamrialrommencos under Chapur6.95 close Califor-
nl Heslth d:Safety Cade,SM6o 625505,25533 and 25534.1 undemaral thui(tM building
Jou iron currently hew a tmanl Nat It l my rmponublity to only the.,.t nr the
requlrtmcnawhch mmet P-91iniu aIaCadraamaramipmcy. Signature of Applicant Date
" " g���=-10 ����� $ All roof coverings to be Class'%W'or better
Owner¢ arisda cm Oam'