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05080158 ;.CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION. BUILDING ADDRESS: JIAN NIU PERMITNO.O 5080158 9712 RTX V nR OWNER'S NAME: PERMIT ISSUE DATE JIAN NIU ONE: SANITARY NO. 'CONTROL NO. ARCHITISCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 2Oo LICENSED CONTRACTOR'S DECLARATION G I hereby&from thns Ill.,I am licensed under provisions of Chapter 9(commencing Job Description n�1w with section 7DAh of Division 3oflhc B aims and Professions Codc,and my liccnve is .. /.. oy men tnmO and erect( DEMO (E) POOL : 1,' ' II ® j,t2? Liccnsc Clan Lie.a DateComrawr f�u ' ARCHITECT'S DECLARATION a'." nU I understand my plans shall W used as public records Q r.00t Licensed Pmfoaam al ( /I/ /S pf�(�[s OWNER-BUILDER DECLARATION Y I hereby aso affirm that 1 1. eaempt from dr Conuxmrs License Law for the ' 00 following¢ssna air,. that tion t I m eamoinha and 1s,Cairns Code:cAny ense y wfoumy `<m ELL which¢quirts a permit to cnnswct,alter,improve,demolish.or mpair any stoncmre $10000 prior m its issuance.also requires the applicant for such permit to file a sigoed statementw wwousT < Nat he islicensed pursuanno the provisions of the Comractor's License law(Chapter 9 Sq.Ft. Floor Area tau � ''� Valuation Y?�C (commencing with Section 7000)of Oiv'uion 3 of HC Businessand Professions;Code)or y that be At exempt therefrom and the basis for doe Muload exmption.My violation of Section 7031.5 by any applicant for a Permit subjeett the applicant to a civil penalty of �kmr Occupancy Type s not more Nan firs hundred dollars($500). ©.1,o owner of the propenyl m is employees with wages az Hai(cmIce.compensation,Business will do the work,and the he Comic not intended d wORertd is nalc apply 70aa,owner of and Rtywhobu Code:mpg Coniremen,and law doh not apply w an owner of Required Inspections ownenywho buildsor ed that Hereon,andwho dohsuchworkhro offered his own c however, the h,provided the such improvement art not intended m o@rod for sales If. however He building or improvementproving is sold within one year of completion.Nc owe of builder will have the burden of proving Nw he did not build or improve for purpose a( .it.). 151,a owner of the properly,am exclusively contracting with licensed contractors to tonswct the pmjw(Sec.7OCJ,Business and Profhsions Code:)The Conuutors Li ` cove Law does not apply to an owner of properly who Wilds or improves themon,and who contracts for such projects with a conuactor(s)licensed pursuant to Ne Conlnc rea License Law. ❑lam exempt undt ee B&P C for Nia lesson Owner ,l/ /`(T/ D.rt WORKER'S COMPENSATI DECLARATION I hereby alarm under penalty of perjury arc of the following declarations: 1 haw and will maintain a Certificate of Consent to self-insure for Worker'aCompen- 105W um,As .video for by Section 3700 of the labor Code,for Ne pen orour ca of the rk for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,a required by Section of the LaLor Code,for Hw perforrnanee of dm work for which Nis permit is issued. y Workeri Compewuon Insurarrce artier end Policy number arc: gier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Mh section Treed not M completed If the permit is(wont hundred dollars($108) or less-) 1 certify out in the performance of the work for which this Permit is issued.l shall not employ any permn in any manner or to We me subjecuo the Workeri Compensation lawsCalifornia. Applicant yes � NOTICE , NOTICEE TO APPLICANT.IL after making this C ons of of Exemption.abod you should bwhwi Subject y the Wortcrb Compensation provisions of the tabor Cock,you must .,Q forthwith comply with such provisions or this permit be deemed revoked. - z� CONSTRUCTION LENDING AGENCY (-. I hemby alarm that Vert is a commoctian lending agency for this per(aronance of a He work for which this penot is issued(Sec.ID 7.ON.C.) It]0 Le.dcri Name = z Lcodcr's Address U O 1 certify that I haw mad this application and sum that the above information is [I. P correct.l agree to comply with all city and county Ordinances and sum laws relating to pV building construction.and hereby aurborim miumstratier of this city to enter upon the r W above mentioned Property for inspection purpose& (We)agree to save,indemnify and keep harmless Ho City of Cupertino against F'h liabilities,judgmenu,costs and expenses which may in any way acenm against mid City V z inPPLcICANTUNDERSTANDS AND s Permit. AND WILL COMPLY WITH ALL NON-POINT Issued b Date SOURCE RE LATIONS. y O/O Si nawrc ApplicanUCont(x Y Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will IM applicant or future building reentrant store or handle havardous material az darned by 0¢Cupcnine Municipal Code.Chapter 9.13,and the Health and Safety oda oY s zss3z(an f7�f,� All roofs shall be inspected prior to any roofing material being installed. Will the Applicant or(mmubuilding mupamuse cyvipmcntar devices which If a roof is installed without first obtaining an inspection,I agree to remove it havardous air contaminant as defined by the Bay Arta Air Quality Management all new materials for inspection. ld.� 0Ycs iXNu1 havereal He WiaNnus materials reyuiremcnu under Chapmr 6.950(rhe Califoo-Health&Safety Cod,Secums 25505,25533 and255X.lundetend dearifthe Wilding not curpmly haw a enms Nat it u my rhpomihility a noulY Or a<upmt of Nc uimm t cbm bcmet p6orwissmceofaCcrdficaw LD Signature of Applicant Date (y �'ner Ora nodacd agent DateAll roof coverings to be Class "B" or better Community Development t 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: l g 73Z i GI Y PERMIT# d&O(S OWNER'S NAME: 5 Z IV- PHONE # —3o SAH GENERAL CONTRACTOR FAX# I am not using any subcontractors: O� Signature Date Please check applicable subcontractors and complete the following ' ormation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring. Carpeting 4 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 2f�7 ��- Owner/Contractor Si tore Date OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform 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. _ 1 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 Owner'speSignatur / � Date: 15 2-Dd / Job Address: I / 7 3 Z Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department CIT'OF 10300 Torre Avenue C U TpE R T'N O Phone: (408)777-322 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. 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 vrotect vourself from possible liability if that person applies for the proper permit in his of 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 unemployment compensation• 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 specific 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 r - CITY OF CUPERTINO DEMO CITY OF CUPEkTINO PERMIT APPLICATION FORM APN # � 6 q a � b/�+ Date: � U Building Address: 1 7 3 Z Y. Owner's Name: S Z Phone#: 1-4-6=7 o SCH� Contractor: License#: Contact: S Phone#: 9 -z9YO(O Applicant/Col9lractor: S' Z Building Permit Info: B E t PIA M Job Description: Q lfl t l� 19 Residential: Commercial: Sq.Ft. Floor Area: — $/Sq.Ft.: Architect/Engineer: Valuation / til 0—vv Type of Construction: Occupancy Group: Qty. if A licable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG 2 3 � � ,