06010135 CITY OF CUPERTINO v r ` ' '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIOM
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BUILDINGADDRESS: QIANG CAO PERMITNO.06010135
15 PARK VILLA CIR
R'S NAME: PERMIT ISSUE DATE
QIANG CAO 01/25/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EISCT PLUMB MECH
uw0 LICENSED CONTRACTORS DECLARATION
1 hereby attire Out 1 am 0mmcd under and
Praf ss of sCoca. 9(commencing] =sJob Description
� with section 7IXXI)of DivirionJof NC Business and Professions Coca.and my]me=is
in full force and affect. ]Gf ���
» REMODEL BATHROOM NON-STUCTURAL)(fr
�q—Z License Claim Lic.N
-moo Dam Contmcmr REPLACE WATER HEATER
WaE'3 ARCHITECTS DECLARATION ^']
-a I understand my plans shall W used as public meorde
a
k G 5 LiccmcJ Professionals•G -75F-2006
g OWNER-BUILDER DECLARATION LJ
g<F I hereby affirm on 1 1. exempt from the Contractors i Any C Law for the
5 p o which following mason.(Section RI31.5,Business and are.de um Cndc:Any city s county A pM ftl' y`� 1Y
m which requires a Permit m cnnstmcr,elver,impmw,demolish.or repair any structure `u q F:A t11 (g tl.l�,l Ifs tl R�,A
z y prior m its issuance,also mquinm tM applicant for such Permit o file a signed staremcnt
FSGthat he isliconadpursuanttoOnprovisiomoftheContractorsLicenseLaw(Chapmr9 Sq. Ft. Floor Area 6400&bVal6hti6ffi
yl- (commencing with Scnss imh 7")ofDivision3 of the Busineand Professions Code)or �� as td Vj
y Nat he is exempt thcmfmm and On basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of ane APN Number Occu-Type
not mom than five hundred dollars(55006 35610061 . 00
Number
p y
I,m owner of the property,or my employees with wages in their sole compensation,
will do On work,and due awcmw is hat imended or offered for sale(Sec.7(194.Business
and Fmfcssimu Cox:The eah rsemes uerue law drawl wit pply en an owner of Required Inspections
property who builds orimprmes tMmon,and who doessuch work himself orthrough his
own croploycus,provided Nat such improvements arc not intended oroRemd formic,if.
however,Ne Wilding or improvement is mid within one year of completion,the names
builder will have 0w Wrden of proving that M did not Wild or improve for purpme of
ate.).
U•1,ea owner of IM property.am exclusively convecting with licensed convacmrs to
commet the pmject(Sec.7004,Business and Professions Case:)The Conummes Lt.
tens,taw does not apply m an ono er of propeny,who Wilds or improves t emon,and.
who contracts for such projects with a caricaturist)licensed pursuant o On Contractors
License Law.
❑I am uempt under Sec. ,B 6 P C for this muon
Data G
O'CLARATION
1 Mmby affum under Painaltyofperpory one of doe following declarations:
Cl 1 haw and will maintain a Certificate of Coram to self-insum for Workers Compcn.
workwork(m provided(tor by Seniors 37110 of IM labor Codc.far the periormance of the
for which this permit is issmtl.
❑1 have and wilt maintain Workers Compensation I...as societies by Section
37M of the labor Cox,for Ne porImm succ of On work for which this permit is imued.
My Worker's Compensation Inmmnce carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissecdon need not Meumpleced lithe permit is form=hundred dollars(SIM)
or Ica)
I certify Out in the performmce of in,work for which this permit is issued.I shall not
employ any person in any manner=as b,M�omcm led to lM orkeri Compensation
Laws of California.Date , 1 f 7 Lr�,t i� �_
Applicant .'!An' / s
NOTICE TO APPLICA ,e mr heakt 0 Ccniftcaleof Exemption,you shnuM
become subject to the Worker's Compeoau revisions of IM Labor Code,you must
Oforthwith comply with such provisions or this permiuhalt W deemed invoked.
Z' CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that there is a comtmctinn lending agency for On performance of
a lM work for which this permit is issued(Sol.3097,Civ.C.)
Wti A lenders Name
D Z Landers Address
CJ Q 1 comfy that 1 have read this application and au¢Nat IM aWve information is
<L F came(.I agree m Comply with all City and county ordinances and stow laws relating to
O V building construction,and hereby autborne mpwsenmiw or this city to enter upon the
4[l
above-mentioned pudgmems.property fond c.onion purposes.
H R, (We)agree to ave,indemnify and keep harmless On City of Cupertino against
C)Zbabilimimuceoftheemtsand expcmrsmit. may in anyway aernwageimmaid City
in eonsequencc of IM granring of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU ONS.
Re-roofs
o
Signawrc olApp w HAZARDOr MATERIALS DISCLOSURE Daw Type of Roof
WilllMapplicamorruture ildingxcupantuomorhandlchuarduusmawrial
cnhed by the Cupertino Municipal Codc.Chapter 9.13,and tM Hcalth and Safety
.Section 25532(9)?
ElYm All roofs shall be inspected prior to any roofing material being installed.
�Na
Will the applicant 01 furore Wilding up..use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
corn hazardous air contaminants as defined by the Bay Area Air Quality Management
District? all new materials for inspection.
❑Yca 9No
1 have mad the hazardous materials rcquimmcnts under Chapter 6.95 of the Caliror-
nue Hcalthsk Safety Cox,Sections 255)5,25533 and 35534.I understand thin ifthe Wilding
drca not commit,haw a¢moa Nat it IS my responsibility m notify do actipart or the
revaircmantsw��uthe me(put armissuah«aracecutI- IOC7ey,pD� Signature of Applicant Date
1--orOwr rar.amor„�aasenf jI2 / All roof coverings to be Class "B” or better