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idea" TRACT0R INFORMA' I01Y.
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
SHIAO MEI NAN LLC
PERMTNO.06050119
10148 BRET AVE
OWNER'S NAME:
PERMIT ISSUE DATE
SHIAO MEI NAN LLC
riONE:
SANITARY NO. CONTROL NO.
ARCHTIECT(ENGINEER:
BUILDING PERMIT INFO
BLDGO EO PLUMB MECHO
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affhm that 1 am Iimoned under provisions of Chapter 9 (commencing
with Sedan 7008) of Division 3 of the Business and Profese.. Codeand my license Is
inmBfasaand eftect.
SFDWL 3732' TWO STORY/GARAGE 473'
License CI s Lk. N 1
Dona — Coouxe6 4
SANITARY IS SUNNYVALE'S JURISDICTION
AR HITECTS DECLARATION
I code fid my plums aboll be used le public rcemm
Licensed Pomranional
OWNER -BUILDER DECLARATION
I hCmby aBom that I am exempt frum the Cormeclor's License Law for use
following reason. (Sudan 7101.5. Butanes and Profession, Code: Any City or County
.
which requiRs a pCrnlil W CnnrmrlC4 eber. impmVe, dtmnlish. M -Pat' any Yracco rs
prior W its issuatae. sista requires she applicant forcech permit W RIC a signed statement
Li Law
Sq. Ft. Floor Area
Valuation
died Wthe Provivimuaf theeBuxeWss cense (C odc)or
Semon M70DO)the Of Division for, C Business and Profession Code) car
$826695
minung with
(commencing with
Nat be W attempt Ihurefrom and do basis far the alleged exemption. Any violation of
Section 7031.5 by u0' applicant for. permit subjects the applicant to a civil penalty of
APN Number Occupancy Type
sat more than five hundred dollars ($571).
I] 1, as owner of Ne property, to my employes with wages n thehrole Compensation,
will do dmework,and the suuc'um4 mmtintnded oroffered(araa4(Sec. 7014, Busiese
- Required Inspections
9 P
Cade: The Contractors License Law dome t apply to an owner of
and profeaslone mo
property who builds or improves therms, and who does such wart himal r or through his
own employees, provided that touch improvements tae notimmrded oroQcre l for sale. B.
kawever, the building or improvement is sold within am yCer of ermPkuan, the owner.
Wilds, will haw that burden of proving that M did not Wild or Improve for purpose of
sic.).
❑ 1, as "nor of the property am exclusively conbuaing wish licensed unu um, W
Conanrcs she project (Sec. 701x. Busine s and professions Code) The Comncmr's I.I.
-
mme Law does act apply W are owner of property who Wilds or Improves thsnam. and.
who comncu for such projects with a antraMr(s) Ilannd pursuant W the Conuacurs
Licari Law.
❑ lameaemptunder See ,B&PClmddsmace.
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby anion coder pealty of perjury one of the following declarations:
❑ i haveand will maintain . CeWficau OfC... Wself-inaurtfmWorkeM1Compen-
sation, as provided for by Section 3700 of the Lab" Cods, fm she performance of the
work for which this permit is lawd.
❑ 1 have and will maintain Worker's Compensation lasursce, u mquimd by Section
3700 of the Labor Cade, for the performance of the work for which this peal' 4 issued.
My Workers CPe ado. Inee c er and Policy numberarc:
Nm
Caer: [((q/� Policy No.: ��r'J��-
rri
CEesus
RT' ATE OF MEMPION FROM WORKERS'
COMPENSATION INSURANCE
'
fnhW seetla used not be completed If the Pont' Is Forane, hundred dellsos ($1010
fir lass.)
I unify dent In thC performance of the work for which this paamlt Is Wood. I shall net
employ any person in say msmrso as W become object W that Worked Compensation
Laws of Caltfomiu Date
Appllam
NOTICE TO APPLICANT. If. after making this CemOau, of Exemption, you should
become object ke the WorWs Compensation provisions of the Lader Code. you mus
foMwith comply with such provisioner or this permit shall te deCou d revoked.
J
ON LENDING AGENCY
CONS...
a. agency far she perfa..... f
1 W that them h a
ed (Sec. 7, Cing
be work fur which Ws permit W issued (Son. 3097, Civ. C)
r which
Lenders Nuns
'
Landeta Mdres
r
I certify that I have mad this application read Cast that the above information I.
coram. 1 slime 10 Comply with all city and county Ordinances and rum law, relating la
building coneauction, and hereby o'horla MirMemmgmives of this city to mnmr upon the
7 above-memomcd property for inspection pugmser.
(We) agree W save, indemnify sad Jump humles the City of Cupertino Clain
I Ii.bilidq Judgmcom,co s and eapema which may N any way scone agalmtsld City
/
r in conte mence of she gremini of this permll.
+ APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON -POINT
Issued by: Date (/
SOURCERON
EGU
Re -roofs
of AppliandCanuecnrI Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will da, applicant ar face Wilding oaupantsuhe or hank hnallous material
as defined by the Cupertino Municipal Cade. Chapter 9.13, asW the Health and Safety
Conk, Seeda35533(01
All roofs shall be inspected prior to any roofing material being installed.
QYes fq No
If a roof is installed without first obtaining an inspection, I agree to remove
Will dor applicant or Tut m Wilding occupant use equipment at devices which
coil hacardffill air canuminants as defined by the Bay Ara Air Quality Mangcmenl
all new materials for inspection.
District?
❑Yes u
IhovereadthehasM . rialsmquimmcnuumde,Ch.pw,6.95.fthecalifor-
nialicoldnhs.fmycode Smtitms 35503, 35573 um 14.1 uMcntandthmifthe Wilding
dos net, ... ilyhow.ten:1 dotIt4 mYnen hllity usnody the oaupol ofum
rtyulrcmcnuw nm rt a 'res aracertihesteoraap
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or atamadnre alien Date '