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CITE'OF CUPERTINO
BUILDING DIVISION PE • 1 T CONT, TO �
BUILDING ADDRESS: PERMIT NO.
10296 VIRGINIA SWAN PL HSUAN WEA WANG & I FANG LIU 107020023
OWNER'S NAME: PERMIT ISSUE DATE
HSUAN WEA WANG & I FANG LIU02/06/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+o p LICENSED CONTRACTOR'S DECLARATION
U F- I hereby affirm that I am licensed under provisions of Chapter 9(commencing lob Description
;Z� wihScclion7000)ofDivision3ofhcBusincssandProCcssionsCodc,andmyliccnscis ADD CEILING JOINTS, SHEET- ROCK, CEILING LIGHTS
t y in full force and effect
)-Z License Class Lir.u EVERGREEN HOUSE CO IS THE CONTRACTOR. . .THEIR
F,O Date Contractor
ARCHITECTS DECLARATION
i at 1 understand my plans shall he used as public records
.MU
WO I- Licensed Professional
ti
OWNER-BUILDER DECLARATION
a 1 hereby affirm that I am exempt from the Contractor's License Law for the
C qo O following reason.(Section 703 1.5,Business and Professions Code:Any city or county
t which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to Glc a signed statement
x< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valuation
y CFCO (commencing with Section 7000)of Division 3 oC the Businessand Professions Code)or $9000
y 5 that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally off Number Occupancy Type
not more than five hundred dollars($500). 3 1 6 4 6 0 0 5, U U
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q
property who builds orimproves thereon,and who does such work himself orthrough his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. ,B&P C for this reason
i
L.
Owner '��- � Date'%�1 V
"WOR CER'S COMTENSATION DECLARATION
I hereby aff(mt under penalty of perjury one of the following declaration.
❑ 1 have and will maintain a Certificate of Consent to self-insure for Worker'sCompen-
sation,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 required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
([his section need not becompleted if the permitis Corrin hundred dollars(5100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner sq to,6c c std the Workers'Compensation
Laws of California Harep•. /"
Applicant ":� f — —'
NOTICE T APP :If,al ei:"-Vimus CeruGt.ate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z""" CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
Ix the work for which this permit is issued(Sec.3097,Civ.C.)
WGI. Q Lender's Name
2 Lender's Address
U Q 1 certify that I have read this application and state that the above information is
Ct. — correct.1 agree to comply with all city and county ordinances and state laws relating to
O building construction,and hereby authorise representatives of this city to enter upon the
W shove-mentioned property for inspection purposes.
G1ti (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permi.
'r APPLICANT UNDE-S�A�A ILL WMPLY WITH ALL NON-POINT Issued by: Date
SOUR
Re-roofs
Signature�1`Applicant/Contractor Dattr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Codc,Section 25532(a)?
Yes All roofs shall be inspected prior to any roofing material being installed.
❑ [�No
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
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
E]Yes o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hca lth&SafctyCcdc,Sections 25505,25533 and 25534,1understand thatifthc building
docs not currently have a tenant,that it is my responsibilit Io notify the occupant of the
requirements which must be met to issuance crlificate of07oup cy. Signature of Applicant Date
-s' n All roof coverings to be Class "B" or better
Owner or authorized agePDate
CITY OF CUPERTI1q0ZO2
03
CITY OF
cuPF�roNo PERMIT APPLICATION FORM
APN# Date:
Building Address: Mailing Address (if differeaf from building address):
Owner's NarneP Phone #:
Contractor: License#:
I0/'_ poin
Contact: Phone:,4o --s61--S5t, Cupertino Business License#:
Fax:
Buil in Permit Info:
?t
g �� Cep I T�9 �orti--tf � S�:-� �C�•., � r�� ��` �T ��
J
Bldg ] Elect D( Plumb ❑ Mech
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: '0 c O` Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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