08060068 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �,Ci)NTRAGTnR INk'QRMATION '-
BUILDING ADDRESS: PERMIT NO.
10409 BRET AVE OCCIDENTAL EXPRESS 08060068
'S NAME: PERMIT ISSUE DATE
_HENGYU GE 1019 HOWARD ST 06/09/2008
ONE: SANITARY NO. CONTROL NO.
(510) 676-7718
ARCH=fFNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
300 LICENSED CONTRACTOR'S DECLARATION Job Description
m I hnmby affirm Nn 1 am liceveo05CT1P
d under provisions of Chapter 9(commencing -
weer Section 7")af DiAmm 3afthe Budnesarel Profalmss Coca.md my ties.is RPLC CBNT CNTR& HD IN KTCHN &4 BDRMWNDWS, NO
in full roe¢and edetic
LicansClass Lien ELCTRCL, NO LIGHTNG, RPLCE PLMBNG & HOOD
9 F DateContractor s
ARCHITECT'S DECLARATION
U I understand my plans shall W died as public mend,
v
G x Licensed Professional
I GWNER-BUILDER DECLARATION
f 1 hereby eRum Nat 1 am exempt from the Contractors License law for the
COO following mason.(Secede 7031.5,Baseness and Professions Cade:Any city or county
$ri which exam.a permit to cmuwct,elect,impmw,dant li h,or¢pair any stmnum
Irritate its issuance.alsurequircs tWapplicant forauch Permitmfilt asignedsutcment
Nm he is licensed pursuant to the provisions of die Convector's License Law(Chapter9 Sq.FI. Floor Area Valuation
x€Q (commencingwith Sation70D0)of Division3afthe Buslnessand Professions Cellular $12000
yu that he Is exempt Nelefmm and the basis for the alleged exemption.Any violation of
Seldom]0.113 by any applicant for a permit subjects the applicant to a civil penalty of
noepN Number Occupancy Type
t mem than Rw te
barWd ,
dollars($S=. 37510027 .tkN P Y yP
1,a towner of the theputaamy at Woycv withwagsv Heirsan.em4,Rod n,
red do ile wart and the he Con is LMCs draw du Torula(Sac.]Din.Buser•of
uW property
who
Cade:mpr Comtmtors License law doe ort appy to in owner of Required Inspections
property who Wllea vi impow tWrtom,and wW sant in work himself a lIluvugb his
howme c .theWiProg or idutsuah iiai mid arts whin not intended artificial fa solea,
however.the Wilding or impromnent u sold within one Sear orimprom for dr Owner.
of
builder will Nw the burden of Proving that W did net build a improv far purpose of
sale.).
1, a owner of Ne ropen,am amin Wel,contracting with licensed cenmcmm in
construct the project(Sec.7044,Business and Ftof ssemts Code:)T1ec Contractors LL .
cense Law dao not apply to an owner of Property who Wilds or improves themen.and.
who canonical for inch pmjeets with a contractors)licensed pursuant to the Contractors
Means law.
❑I un exempt undo See .B B PC for thisW. masev
Dau
MF WORKER'S COMPENSATION DECLARATION
IWmby affirm underpenalty of pejury..of the following dcamtibms: -
❑I ham and will maintain a Cndfievs of Covent to self-insur for WakersCmnPem
salon, pro fPe Section 3700 of the Labor Code.fm Ne perotmerec of the
wort forr whichh this Permit is issued.
1 haw seal will maintain Wo len',compa safes Insvtvtce,u"Wred by Stairs
371)0.(the label Code.far the perarreanceo(the work for which this permit is issued. '
My we aCompewdeal m ccarimand Policyrunsame:
Career. Polity No.:
CERrIF AAEXEMPTION FROM WORKERS'
COMPENSATION NSURANCE
fDeis orlon need not W completed if the Permit is faame hundrtddollan(SIM)
or 1.)
1 certify Not in the Perfaevrrcc of tW work fa which Nis permit is armed.I shall not
employ any person in any manner so as m become subject to tie WorkesCompcsaaeon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifrcata of Exemption,you should
become subject to the Worker's Comp reed an p tpeulm u of tM labor Code,you mail
.J O faMwith comply with such Pmvia es ar this permit shall W domed mwked.
z"" CONSTRUCTION LENDING AGENCY
r
[-v hatedlY thi th e thcrt'sawn(See.309,ding a6tnry rel diePMormanv of
IY the work for which Nu permit is isned(Sec.3097,Civ,CJ
LEI A Lender's Name
z lenders Add.
U Q I certify Nat I Mw mW this application and state Nm de above information is
[T.F correct.l agree to comply with all city and county on inarres and mu laws mining to
0 U Wilding asesuacumn.mW herby wthomm mprvenmiwso(Nu city to tins¢upon the
Y'LU +time-mentiured property for inspection pmitoses.
t„r py (We)ogre to saw,indemnity and keep harmless the City of Cupertino against
rn Iiabilidni,Judgments,casts and tiresome which may in any way gases against said City
U Z in consequence of the Starting of the Permit.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b : —�/-<
S402�
SOU REGULATIONS. Y Date 6�
Re-roofs.
Srgnmurt of ApplicanUContracta Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding raupant slam orhandle h ummous materia '-
Tenth by Irk Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
o uuslz(+)] CEtNo All roofs shall be inspected prior to any roofing material being installed.
_ wn ort, Rnnt.r rotor Wudie olid+m a If a roof is installed without first obtainingan inspection,I agree to remove
pP t P eaAirQu or device which P gm
emit hazardous air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection.
Dimict7
❑Yca XNu
I hew rad the haraWoa maMrialmrquirmems under Chapu06.95 of tht Califon
nu lirshmA SafctyCadc,Stands 155W.25533 am125534.ImWcrnand thmifte,Wilding
does out a ronry haw+Montt,out it a my territoriality m rmdfy Nt occupant or the
mgmmmc 'h mist W met Prior W issuan¢of a Cenifeac of(kcupavy. Signature of Applicant Date
ow thoaacdastrt Date' All roof coverings to be Class';W'or better