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05060035 (2) CITY OF CUPERTINO `?+ BUILDING DIVISION PERMIT CON TRACT0,RiINF0RMATI0N :F, BUILDING ADDRESS: _ MING ZHEN YEH PERMITND05060035 OWNER'S NAME: PERMIT LSSUE DATE MTMn 797N VF9 JNE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 Lop LICENSED CONTRACTOR'S DECLARATION JobDescri [ion x F 1 Mosby affirm that 1 am licensed under provisions of Chapter 9(commencing p SZm with Section 7")or Division 3 ofthe Business and Prokstinu Code.and my licensd is in full forceand effect. ? License Class Lic.0 TEMP POWER POLE Z F p Date Contrmur "J ARCHITECTS DECLARATION 1 underaznd my plans shall be used as public records JyU aro Licensed Professional S OWNER-BUILDER DECLARATION <P I beraxo ulirtn that 1 1. camps s an the Cantramara License law for the p o whfollich reaaan.(Sectionitto cont, t.amus and improve. a ole Code:Any city stmctcounty S: m which myuima a penmen m construct.alter,improve.dcmol6A m repair any mrunum te—m prior to its issuance.also mquiru the applicant for such Permit o file a signed statement thathc ksliccnsed pursuanun the Provisions nfthe Contracture License Law(Chapter 9 Sq.Ft. Floor Area Valuation �Ho (commencing with Section7(XXoof Divuioa3ofthe Butmessand Profusions Code)or i that he is exempt thcmfmm and Bre bazis for the alleged cromption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 51OXNLIGOV0 0 Occupancy Type oat more Nm five hundred dollars(IS(x)). ©'L o ownerk f and property, ra is cmplaycu with wage u their Solt 0,44, uation, will Pr thcwon,and the suumute is not rounded car offc.dLaw do s Ori apply in 44,Business I and Professions carie:The ws diectars License 4w rias or apply m rt owner of Required Inspection own property who buildsvidcd Oat suthereon.andwho am not intended oraffrorthrough his awn employees,er.theip building or i Nat such improvements are not intended enW the oformic.r. builder[Nebuilding car den of pmemg soldwithinone year of completion.provefor purpose owner builder will M1ave the burden of proving Nat he did not build or improve for purpose of sale.). 0 I.as owner of the property,am exclusively contracting with licensed contractors to \ construct Ne project(Sec.7(341,Business and Profusions Codd:)The Contractor's n Li- cerise se se Law donot apply tan owner of property who Wilda or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contrumrs License Law. ❑lam exempt untle Se<.�� ,7 .B&PCT rthis rtazan Owner I�T�M'il- / Date 616/or WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I his ve and will maintain a Certif.tic of Consent m self-imure for Wmker's Campem tion.as provided for by Section 37M of the labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Workers Compensmion Insurance,az required by Section 37W of the Mbar Code,for the performance ornate work for which this permit is issued. My Workers Compensation Insurance earier and Policy number am: Cartier: Policy Na.: _ CERTIFICATE OF EXFMP ION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not tecompleted if the permit is far one hundred dollars(SIM) nr less.) 1 ccrufv Nat in the performance of the work for which this permit is issued.1 shall not cmployanypersoninanym robe sabjecuatm Workc Compcnaatian LawsCalifornia.Date Applicant NOTICE un APPLICANT:If,after making this Cisions of of Exemption,you should baomd subject ro Be Worker's Cmmpeosstion Permit steal of the deemed CMe,you mut .JO faMwithcomply with such provisions;of Nu pcSmit shall bedamcd oswkcd. , Z71 CONSTRUCTION LENDING AGENCY [— I hereby affirm that Nem is construction lending agenry for the Performance of fY thc work for which this lemon is issued(Sat.3097,Civ.C.) 0 Lenders Name = z lender's Address U O I cenifY that I have read this application and sure that the above information is !T. P Corea I agree to comply with all city and county ordinances and suite laws rearing to 0 U building construction,and hereby authoring rtpresenmixes of this city to on=upon the >" W ahovc-mentioned property for inspection purposes F Q. (We)agree 1.save,indemnify and keep hafmkss the City of Cupertino against V liabilitiu.judgmcnrs,costa and expenses which may in my way¢retie against mid City nsequence,of 00 .an.,of his permit, U Z APPL CANT UNDERSTANDS tAND WILL COMPLY WITH ALL NON-POINT Issued by: Dateo/C.f' SOLI_RCE,aEOULATIOd� signutrre a� � n canmemr (p�� Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future building occupant store or handle hsaurdous material az defined by the Cupeniao Municipal Code,Chapter 9.12.and tW Health and Safety ale. ion a, E�.I( All roofs shall be inspected prior to any roofing material being installed. �Ycs JNtr Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air comaminanu as def ncd by tW Bay Arca Air Quality Management all new materials for inspection. isaicR Cl Yes JaMa 1 have maJ the hamnJous materials mquimmcnu under Chapter 6,95 of the Califor. ^ice Hcalth.i Safety Code,Sccdons 25505.25533 and 25534.1 understand that if the Wilding does not cumendy have a boam,that it is my MSPonsi hility to notily the oocupmt of the require nu h Qbe Met Prior olssumccofaCertificate oyVo�aparey. Signature of Applicant Date°!6/eJ� Owner or amhodzeJ agent Dam All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPERTINO Building De artment JOB ADDRESS: PERMIT# 9—ft, x.35, O R'S NAME: ov PHONE # qof- 3 to— 06 GENERAL CONTRACTO • / FAX # I am not using any subcontractors: �>G /U ignatu4 Date Please check applicable subcontractors and complete the followinginformation: 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 Owner/Contract r Signature Date OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. A All the work authorized by this permit B. = A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2 A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). Property Owners Signature: ; Date: 6 Job Address: C U 4 r/ A V5 Permit# b S a 6 0 0 3 S Any changes to the information provided on this form shall be submitted to the City of Cupertino Build DeDaarlment. City of Cupertino Building Department CIT'OF 10300 Torre Avenue C U D C kT I NO Phone: (408)777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements spedfied. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. if you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors,then you may be an employer. if you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers compensation insurance,disability insurance costs,and unemploydment compensatiov contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more spedfic information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper ` CITY OF CUPERTINO J TEMP POWER o PERT UINO PERMIT APPLICATION FORMIC APN# -� Date: Buildin/g,Address: / 0Y--/ LW5DA-Li CU &27civ �fF Gj Owner's Name: Phone #: Al Cc*) 3 /0 �06 Contractor: Phone: License #: 0 DKW e- Contact: Phone: Cupertino Business License #: Building Permit Info: Elect Job Description: T4,P" ov✓e/L . Residential Commercial ❑ Cost of Project: 1-P- V-19 Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING