06010174 CITY OF CUPERTINO
BUILDING DIVISION PERMIT dNT.ItG"T'IQIt YNMT �'.� , ,.
BUILDING ADDRESS: D & D CONSTRUCTION 'ERMRN0.06010174
18969 BARNHART AVE
'4It's NAME: PERMIT ISSUE DATE
SHIHONG LIU 1447 HAMPTON DRa 03/06/2006
p NE: SANITARY NO. CONTROL NO.
(408) 666-5298
ARCH=IENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0
�OzLICENSED CONTRACTOR'S DECLARATION
1 beauty affirm Nu 1 am Reeved under provisions,or Chapter 9(commencing Job Description
H Secdon 70fkL)of Division 3 of the Boaineem and Prof"llom Cade,and my license le
n� in full to=and effect. SFDWL- 2 STORY 2, 203 '. /GARAGE 441 '
�Z Lima.0. LIC.g
? —
Data Contractor
ARCHTECI'S DECLARATION SANITARY BELONGS TO SUNNYVALE
Y I undersand my plans shall he used u public records
=� Licensed Professional
OatNEm exempt
DER DECLARATION
I hemhy.Eine on I am exempt from the f ssion Co License Law for the
O G following roasnn.(Section 7(131.5,Bu Man. and Na,de Profession Code:Any oily m coumy
z$ whichor )its isu a permit re cnnsuueL Man.Improv,demolish.t or e a sig any ttrucwre
_Z�' pd,M is
iensedprsuant toilaa theapplicantfor men ConincmU mflea Law(ned Chapter
pp9< WtWislianscdpuswemmtWpmvisionarlthcComromrlLIanselaw(Chapter9 Sq.F[.Floor Area Valuation
of D (commencing with Section 7000)of Division 3 of the Business and Prolamines Code)or $$500000
that he Is exempt therefrom and the basis for de alleged exemption Any violadon of
Secdo 7031.5 by any applicant fora permit Objects ft applicant m a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollssa($300).
❑1,u ownu of the property,or my employees with wages u their tole computation,
willdo duwork,andthest Lula BrotinmndedmoRemd fanalc(Sec.70A4,Bwinass
and Profeaslons Code:The Contractor's Llanse law does not apply to an owner of Required Inspections
property who builds or Improves thereon,and who dot such wok himol f or through hit
own employees,pmvided the each Improwmmu arc notimmnded orofiend fmsak.Tf.
however.the building or Improvement is old within ons year orcompletion,dm owner.
Wilde,will have the burden of proving that he did of Wild or Improve for purpose of
um.).
1,u owor the property.am exultantly engineering with 11.394 coeuacron to
cmutmct me project(See.7044.Businru and Pn(esdars Code:)The Columnar,U.
rove taw does not apply to an ovmer of property who Wilda or Imprusv Hereon,and,
who contracts for such pmjecm with a canuacmr(s)licensed pursuant to the Comranmrs
License taw.
❑1 oro exempt under Sec. .B k P C far this regio
Data Wile,S O46
WORKERS COMPENSATION DECLARATION
I thereby aL under penalty of perjury,arc of Hr.following deulandons:
❑I haw and will maintain aCenifscem of Cansent to ol6usum forworkersCompeo-
odor,as proL for by Seedo 3700 of the Labor Code,fm the performance of the
work for which this permit is issued.
❑1 Mw and will mmnWn Workers Compeuadon ivunnce,as required by Sectio
3700 of Ne Ia xe Code.for the performspa of the wart for which this permit Is Wand.
My Workers CompevWo In mmun a curio and Policy number ase:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(pt4cedm sed Out becomplem l If de permit is(moo h radmdd.11.($im)
or maL)
I certify thou in the poiltur once of Ne work for which this permit u issued.I shall not
=play say Peron in any at aW36eGaelubiectOm Ne Workers'Compuwtion
Uwaor Caliromia.Dato
Applicant
NOTICE TO APPLICANT:IL after making this CeniOeeu of Exemption,you should
become rubject to the Worker's Compensation previsions or me Labor Code,you most
.7 Z foMwith comply with such provisions or this Permit shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
(r I hereby affirm Nat Nen les construction lending agency for the performance of
(�7 me work for which this permit is issued(Sec.3097,Cih,C.)
W QLender':Name
az Under Address
U Q 1 certify that 1 have land this application and staid that the,above information is
Iq Fcormci.1 agree to comply with all city and county,ordinance:and sum taws misting m
V building construction,and hemby tumorin repnsenmlvhs of this city 10 emu upon the
{i7 abo a-mentioned property for Inspection purposes.
(We)agree to save,indemnify and kap harmless the City of Cupertino apivt
cony y Habilifies,judgmems.cord and expenses which may In any my aceto against nod City
In V APPPLLIICCANTeof the Swung of UNDERSTANDS AIND WILL COMPLY WITH ALL NOWPOINT Issued by: Date 3' a
SOURCE REGULATIONS.
03 6�o� Re-roofs
Signuure of AppllcantlCanuacmr Data '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant shore or handle ltaaud ous material
as defired by the Cupertino Municipal Cade.Chapter 9d Ill.and tW Health and Safety
section 25531(47 All roofs shall be inspected prior to any roofing material being installed.
❑YesOB No
Will the applicant m fluTwm building aecupam aro equipment or levies which If a roof is installed without first obtaining an inspection,I agree to remove
emit haurdnua air conumivnts as defend by the Bay Area Air Quality Management all new materials for inspection. '
Mulct? y
❑Yes �t'i No
I have mad the hazedwa mucrials requ ireme rats under Ceepter G95 of de Cal ifor.
nu Hcal &SafetyCode.Satiate 25505.75533 and25534.1 undersand ash if Ne Wilding
data of cu sena ly haw a tenant.dw It u my rupeambility to odfy de aecupanr of the
rmpdmrrentswmen mmpdarmismance of,cwBa03 /0 1/ Signature of Applicant Date
a6
Owner mautharived aSell � Pam All roof coverings to be Class"B"or better