08050078 CTTY OF CUPERTINO
BUILDING DIVISION PERNIIT �UIT1tA 'URFF � , v �:'
BUILDING ADDRESS: .. PERMIT NO.
10475 BEARDON DR T & R MhNAGEMENT & 08050078
OWNERS NAME: PERMIT ISSUE DATE
'PZEKING ROCKY CHAN 6172 BOLLINGER RD STE 151 07/07/2008
Pq FINE: SANITARY NO. CONTROL NO.
(408) 329-2831
ARCHITECTIENGINEER: BUILDING PERM TINFO
BLDG EI.E(.7 PLUMB MBCN
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LICENSED CONTRACTORS DECLARATION JobDescri tion
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I hereby afBmat I as Ilcun under p evkiona or Chaps 9(ono ing P
with Sctimet7 10)orDividon 3 of 11M Bust aid Rofudm Code.red my Bowen is SFDWL DEMO
Som mfull(aa wed chme.
sgz_ Lkena Cm Lk.P
as ARCIiOed TS uECLARATION
1 undwe am my plan char ba Med a ptblw meow
3
Licensed Povessimw
5!°8n OWNER-BEIDERDECLARATION
3 1 herby Nhm rm I wl.xamptBusier form Pr Connectors Code:1 Lkwa Law m nor
l•D which re nms,a(Satio 703 omm n,Aha and Avfaaon oAny city or were
$a which nNoru a Permitalso
re.res the aper,Improve,amdW,a ani,say arthro l
pri0rm ha ireniva.alto lyethe the AwmOffar recti Pamir tofrk aa&-(Chmmenl
< Nu he�"imuedprove.ebaeprvviakaoftheConuamYilicael.w(Ch.gm9 Sq.Ft.Floor Area Valuation
�D (ommeaing vvitlrSa0o 1000)dOpvdam3af the BaaauW rtamdos Cade)a $12000
`<8 men he is aanpr deaeftam red tie bah fa the alleged eaemptlm Aq volition of
Section Iml5byamapplkaftfee aPermit nb)aaden appecammacmiperalyOf
hot..e dm nm hammed doll=(3M 32630152 . NumberOccupancyTyPe
❑Laawrcofveepopery.mmy®ployomwlthw.Wunairrekao.pe don.
aund HWnaduns CCoodcft c Liam,Lraaae„Ike o01a'f'�nr Required Inspections
property who,bonds a Improves doom,and who dm rech work bkerlf a through hit
awn enploym,pre, the wait inWwmw M Me not handed aoaaed fceale,B.
however,the building or hnp.van.a L Sold within m YOU afca n ktim.me owrar-
Mader will hoede,bmI ofpoing Lha MdidnotboldaimPmmforrxpmof
ale.).
4 a arm of an Papery,w—A-vely mOuddg with named ammtlaa to
comermet the Project(See.704E Bmkm ctrl Refnaau Cedc)The Comments Lt-
.L.w dm m apply w u owe of PMPeuy who bmMl a hnPm.n thereon.ad,
who emuau fee suck Projects with a causeer(s)Bmtmd prommm to an Comowfs
B=ore I.w.
❑lanawmpuwasea wARKm.//�e10 .BaPcr.thisa
Owner S N DECLARATION
I looby mak.miler i m ity of Perjury ma of But Bellowing deelamwnc
1ham and win meain a c.mnaw wco onwif-imam raworce,compo.
redo.a provided for by Semon 3700 of the Lob.Code.Be the perfamwn of an
work for which IMS Permit is Auued.
ri 1 hive ad will eamtln WobefA compm uwn kswmmra,a required by Section
370D of the labor Code,fee the Performance of the work for which oris perne,I. d. '
My Workee,Canpmmulon bmrea cmicr wd Policy ameba me:
Cartier. Poky No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
('nds mento mW net be compked if ft Permit isform hundred drawn($100)
mks.)
I carry that in as Performance or the wait for which We Permit b Tread.I awl not
employ any Peron w Ary magrcrse w ca ob'ectmthe PymoicompomNo
Lem of CalfmniL Dam_
App 0om r N
NOTICE TO APPLICANT:If,ab main$this Coroffican or Exemption.you NOM
hoomm minor,he oro Woman Computation pmviaam of now LabmrCode.you rue
�O forthwith comply wive mch world=or this Permit chane he msmed mwked.
z^ CONs TtucnON LENDING AGENCY
[--r Them"alio do time is teammucwo kedwg agency(W the anion.sae of
p!,> the work for which this pemit ki ord(See.3097.CW.C.)
WQ LeWces Nana
7 z LadeYS Addems
Uo Iratifythe,Iher,radit"Wlkmimandwnthou the,whamWoman.k
D„E Caveat.l spa w comply with W City W eemly adnetses and sae home mliams w
O building commuctim.went beemy wormian mpmmmlma or this city to core upon nts
W .hove-mentiaad poperry,la Inspection Proposes.
(We)egma he rem,imemafy ad hap hamkre the Cly of Cupoio.gaut
„y r0./1 IAWIIi,Ia,Jpdgmmu.cru aM apeam which may N my wry aceua agAiea aid Cry
of ded;
U x APPLICANTin councepureem,of the UNDE=ANDS AND DWIWILL COMPLY WITH ALL NON-POINT Issued by: Date 7
SOURCE REGU ONS.
ecc=f:C� S Re-roofs
Sigalwaaf Appl=MdC~rm.Ta Dam
HAZARDous MAT ERIAls DISCLOSURE Type of Roof
WAR em appaam or fume bolding acupe useoa ortuage haadoatonement
a meed by the Cupenio Municipal Code Chapter 9.13.ad the Hahn red Way
Code.Seclim 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya QRNo
wa the%Wicem or comm bolding aa'upent um equipment m dcrlaa which If a roof is installed without first obtaining an inspection,I agree to remove
haadom ver emumiream a dermad by the Bay Aa.Air Gantry Mwigemen, all new materials for inspection.
to
❑Ya .-No
1 haw mad the beardnu mamWs mWimmenu under Chavlm695 or the Caifa-
oaHoene ASaayCade Semam 7555.25533.m 25530.1 u*mwa antigen lending
done Met currently hum a lama tie it k my mapamNE,Y In awry da Ment ant or Me
requirements which must a aver Prim mMonaco ver.Catlncim of OMM mtY. Signature of Applicant Date
Owner mwaa' 1 D,m- v All roof coverings to be Class'n'r or better