05080076 CITY OF CUPERTINO ' s: + FIT
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BUILDING DIVISION PERMIT 'CO1Vs rkA,0T,0RINIP`O #TION
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BUILDING ADDRESS: DWK CONSTRUCTION PERMIT NO.05080076
10077 SCENIC BLVD
.R'S NAME: PERMIT ISSUE DATE
STEWART WEN-CHUNG WU 1646 S DE ANZA BLVD 08/10/2005
ONE: SANITARY NO. CONTROL NO.
(408) 615=1508
ARCHITEQ MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0 t� t�
j0o LICENSED CONTRACMWS DECLARATION Job Description
E 1 hereby affirm Nu 1 am licensed under prevision of Chapter 9(commencing
with Sayan 7tM1B)of DIvWon 3 of the Bushmen and Pr xhunau Code.and my It"=is
ry I.full fa...adeffimt. REMODEL-KITCHEN NON-STRUCTURAL
31z Lieensa Clw Ue.a
Dam Contractor ELECT/PLUMBING
DEC
a ARCHRheuse DECLARATION
G I undcriund my Phna shshl he used as public recnrJs
5 U
s G Licensed Prelenional
OWNER-BUILDER DECLARATION
aI hcmhy affirm ren 11. exempt from U r Contractor's License:Anyc Law for the
i:O O following dawn.permit
t 7 o Id,Buainns and improve,
de rens Cod,:Any city or county
5$lei which rcquhu a issuance,aim
m cnnsrmct alcor,Pmpmm,dcasmhah,ore a sig any structure pin
_ZSm pow ltistsensealwntothe title applicant lorauchpctmr recilese Law(stammcnt r
o (that cometacing wait Purwam come of provisions of the ConuaumS lJauclaw(CNpon9 Sq.F[. Floor Ateall f � ValU3L 6500
(coasmen exe pt SeNmti7 and basis n3I allehe ged
and PrmfeniamCode)are(
Nat he ts exempt Merefrom and Me bnsts for Bre nm{rA eumpdw.My vioWion of
Section 7031.5 by wry applicant for a permit subjects u1e applicant to a civil penalty of /�`IprN rl�,im er LJI_L L� Occupancy Type
o
.at de Nan Five hundred dollars($500). 3 f 0V 2 . 00'
01,u owner of Mie property,w my employees with wages as their sale eompenutlon, n 1I�0.
will do the work.and the met..tsmotimaded oreffened for We(Sea.7044,Businessr'i Uired Inspections
§R6
and Professmns Code:TW Conusamr.Let.Law dead not apply m an owner of
propenywmma
ho buildsorimotheran„ Mwhodoadswhwwkhimnlfwduouth his
most employee,provided Nat such improvements art set intended oroffeted for We.If,
however,the building or Improvemat issold within ons year of compmMon,On mwrer.
builder MR Mn the burden of proving that he did not build or improve for purpose of
talc.).
1,as owner of the property.am exclusively contracting with licensed contrsotora to
canstruct the project(Sec.7044.Bush aha Prmfadamns Cada)The Conu atues Lb
came law does not apply to an owner of property who builds or improv Nemon.and,
who contracts for such prejeen with acomanwO)licensed pursuant m the Cono.ctoes
License taw,
❑1
am
rec
exempt under Sec. B&P C for this on
r m
De ',-e'/--=o
WORKERS COMP AVON DECLARATION
I hereby affirm on, penslt. f perjury oro of the following mularma :
❑1 ham aha will main Wn aceninmwofconwnttowlhinum fwwohern Compere
ration,as provided for by Section 3700 of the labor Code,for one performance of the
work for which Nis permit is Wood.
D 1 have W will maintain Workers Compenuuon Inmesox,as ayuired by Section
3700 of Ne Labor Code,for Me performance of the work for which this permit is issued.
My Workers Compensation humourca caner and Policy number are:
Cartier: Palley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin section=ad IwtMcomplemJ tithe permit Is forma,huMreddollare($100)
or I.)
1 certify Nat In the performance of the work for which mis permit is issued,l shall sew
employ any person In any mannr�,s sAm Fie tuby:x1to eworkens Compensadon
L.wa of Cslifomla.O e
Applianl
NOTICE TO P CA :If.After mekj this Onfill nc of Exemption.you should
become subj %to Ne Wotkeh Coope tion provisions of Me labor Code,you most
0z
forthwith comply with such provision or Nis Permit shall be damod revoked.
Zy CONSTRUCnON LENDING AGENCY
[r Ihereby in.Nn Nem is a constmNnn lending agency rmr m,Performance of
CYi> the starts for which this permit Ps road(Sas 3097,Civ.C.)
W Q Lender's Nam.
?z lenders Address
U O 1 certify that 1 have read this application and mm that the abow information Is
V,E coma I agree m comply with all city aha county ordination and state laws relating N
C) SV” building concoction,and hereby authorise dpruenmiv of his city to enter upon me
{17 .have-mentioned Property far inspection purposes
li (we)ume to save,indemnify and keep harmlm Ih City of Cupertino against
m„t rg Iiabilitru.judgmenta,cats and expenses which may in any way accrue against said City
in
of the Swung of
U APPLICANreUNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by:9102�&o Date —O a—
SOURCEREGULAMON5. ,yam. L
�f Re-roofs
Sitnnurt of ApplimuConuactor Data
HAZARDOUS M&MRIALS DISCLOSURE Type of Roof
WIII ft applicant or future building occupant Bm a or handle harudom material
defiaW by Me CupeM Municipal Code,Chapter 9.11,and the Health and Safety
b,Section 15531(e)7 All roofs shall be inspected nor to an roofing material beim Installed.
❑rad Id No P P Y g g
Will Ne applkant or ffu\tum Wilding occupant use,equipment w devices which If a roof IS installed without first obtaining an inspection,I agree to remove
cash hn.Wnu w
air ctsminants uM
dced by Ne Bay Area ma Air Quality Management all new materials for inspection.
onto
❑Yes ID1Nu -
I ham read Nc hwanl/wss maerislu,quieme nu a nder Ch.pmr 6.95 o f the C.l ifor.
Fila Hc.10&SafmyCode.Swdom 2S5f15.25533ud 75534.1 under mad Mention building
don not currently have m terms.Nat It Is my responsibility m modify the occupant of the
mqui dents whnuma elpdwtou,s ofaeertiadmmrOcupwey' Signature of Applicant Date
/pr^ of
Ownetormthorixedagetn Dam All roof coverings to be Class"B"or better