04120083 CITY OF CUPERTINO "' n
BUILDING DIVISION PER ,,Cf)NTRACTOR�INF,ORM•ION:"
ro% gAy 4e, 9,,.. V;
BUILDING ADDRESS: CHI ZHANG PERMIT No 04120083
7949 BELKNAP DR
ER'S NAME: PERMIT ISSUE DATE
CHI ZHANG
PHONE: SANITARY NO. CONTROL NO.
ARCHITELTi'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
goo LICENSED CONTRACTOR'S DECLARATION lob Description
.-7 1 hereby affirm mat I am licensed under provisions of Chaplm 9(commencing Job
sive win Section 7")of Dividon Sof BaC Businessand Professions Code.and my license is
^3y imm�forceandefrea FENCE-7 'ON SIDE/'6 ' ON FRONT
�? License Class Ue.0
ZF W Dam Conuamor
ARCHITECTS DECLARATION
I understand my plans shall x used n public records
>iU
3 LL Li.mucJ Pmf.tsional
'—'0< OWNER-BUILDER DECLARATION -
"s I 1 hereby affirm that I am exempt from the Contractors License Law for the
z p o fallowing mann.(Section 7031.5,Business and Professions Code:Any city at county
R m which squires a permit m conavum,alma improve,demolish,or repair any structure
Fi< Priorto its issuance.also requires the applicant for such Permit to file a signed stacemcm
x thatxlicensed Contractor's Uw(Ch.Pmr9 Sq. Ft.Floor Area Valuation
yam (commencing wit Section 7")of Division 3 of the Business and Professions Code)or
i
that he is exempt Bacterium and to basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Bae applicant o a civil Penalty of et0 0 Occupancy Type
not mom man five hundred dollars(S50(b.
❑ Lazowner of the pmpeny.ar my employees with wages azMeir sole compcnmtion,
will do the work,and the structure is not intended or offered for sale(See.7044,Business
and Prafessimus Code:The Convenor's License Law does not apply m an be,of Required Inspections
pmpeny who builds or improves thereon,and who does such work himself or trough his
own employees.provided that uch impmvemenn we not intended oroRered foraale.If.
however,Bae building or improvement is sold within one year ofcompletion.the owner. _
builder will have Bae burden of proving mat he did not Wild or improve for purpose of
soled.
0 1,as owner of the property,am exclusively convecting with licensed convenors to
cense La Bae project(Sec.7044,wneromand ty who Wilds
Code:)TTeves uencon, Bad '
cense law dors not apply to an owner of pmpeny who Wilds or improves Bacmon,and f
who icC.Ucu for such projects wimacanuutor(s)licensed pursuant me Convector's "'� )
-. License law. 1
S lam exemptunder See. B&P C for this reason 11 1
.r De
.WORKER'S COMPENSATION DECLARATI(eOII /' �((✓✓/ J)//)r'
1 hereby affirm under Penalty of perjury one of to following dTTTeclaranions: / ~,
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- CCC
Cation,as p.OdCd for by Section 3700 of the labor Code,for me performance of me
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of to LaWr Code,for the performance of the work for which this Permit is issued. '
My Workers Compensation Insurance Carrier and Policy number arc:
Cartier: Policy No.: _
CERTIFICATE OF EM MON FROM WORK ERS'
COMPENSATION INSURANCE
mus suction need not becompleted if the permit is Intone hundred dollar(SI00)
or IC..)
1 certify Baa in the perforn c f me work for which this Penni,a issued.I shill not '
weployanypersonina m aztabccgtn 1, ll.te Workcrs'Compcmmior ...
L'
of Cal'omin.I n so M D f`C/ ! uv. _
Nor t=
W. Pd m kir, Co.ma:iTg'Bapr Certificate of of Lab rtion,you u ould
most
.JOW. e t y tic Workers Compensation provisions of di m Labor evoke you must
forthwith comply with such provisions or this Permit shall xdcemcd revoked.
Z N
CONSTRUCTION LENDING AGENCY
[-+ Ihereby affirm that mere is a construction lending agency for the performance of
to work for which Nis permit is issued(Sec.3097,Civ.C.)
V]A Urn crs Nam.
I5.Q Undeis Address
fJ I certify mat 1 have mad mil application and sure mat the have informnion is
0(•-' wilco I agree m comply with all city and county ordinances and Cute laws relating a
QU building Construction,and for
authovesosscnutivuofthisCity mcnter upon the
r 0.
above-mentioned as Cavy fm lemnify an purposes.
(sjuagme as save,indemnifyandkeep may in an wCityru Cup.nstsagainst
F' liabilities,judgmentsecosuand g os this Permit, may in any way accrue against said City /
inConsequence of UNDERSTANDS
of this Pcrmi,.
^ APPLI AM'UNDERSTT�S AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
SOUR�ULATIONS:_r ` `k �aZ/fJ�J
�` J Re-roofs
Signazurc of AppiicamnZommctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ar future building oecupam stare,or handle havudous material
ticfincd by the Cupenum Municipal Code,Chapter 9.12,and the Health and Safety
de.seals 25532(a)7
,]Yes All roofs shall be inspected prior to any roofing material being installed.
'�!o
Will the applicant or furore building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Mesa
1 have read the harardaus materials requlremcnu antler Chvpmr 6.95 of the Califon
Baia Health&Safmy Code.S.cd.ns 25505.25533 and 25534.1 undersand Baa if Bac boiling
docs not curtcnJy have a moans that it is my responsiiility m nastily the xcuPant of Bac
requirementshmhmastxmet pdortaisvaanceof.CeniE.ate.foccpancy. Signature of Applicant Date
Owner or authorived age¢
���Qil e-rf —' All roof coverings to be Class"B"or better
� Dnm