01050175 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11592 BRIDGE PARK CT -., 0.1.0501''75
OWNER'S NAME. APPLICATION SUB DAI'L
ZHENYU QIAN 05/23/2001
.� PHONE: SANITARY NO. CONTROL NO.
na
O OO ZARCHITECI'/ENGINEER: BUILDING PERMIT INFO
p BL GLECIPLUMB MECH
Cam
FFes? LlclarvsBD corvTRncrGR's DEcl.nknnoN Job Description
ZO Z^, 1 hereby ofm,that I ren licensed under pmvieionv of Chapter (eommcncing
F,_f-ti, with Section 7000)of Division 3 of the Business and Professions Cole.and my license ,
se
atEj ishfull force and effect
' TRF_L'hI_$ '
a 6 Lice.Class Llc.a w'�y
O u Dam Comraanr
ad 3 u 1- ARCHITIiCi"S 117CLARATION
undcaland n, II be used as blit records
lily IT public
w pO
Licensor!111...rand t
m'e� OWNER-BUILDER DECLARATION
nx+=m '1 bmt,by ultinn thin 1 ma exempt face.the Committee's License law Entire
f-Z< following maim,(Section 7031 5,Bminca.and Profession,Calc:An,city or county
S S p which requires a Permit to consmuct,altar,improve,demolish,or repair any structure
Primmi"issanuum,dsn...... lhu npplicunuor wch perndunlilt aligner simement
that he is licennd pursuamto the provisions of the Commaoh License Law lChapmr 9 Sq. Ft. Floor Area Valuation
(coounencing or Scale;,700x)of]),,man 3 of the lirsin,e,and I'mfasionv Co c)
nr that he is exempt Bambara and the basis for the alleged exemption.Any violation
of Scaio 1 703 1 5 by any upplicunl In,x parson subjects the applicant to a civil pim.he
urn.im than rvebaddreddollars(s5no). APN Number Occupancy Type
[II/ rnrn,cvr^nenr.orn,ven,nleyec,web wngee aabeir pore nmltpm,.mmn. 7 171171
will do the work,and the souaurc is not intended or immed for.sale(Sec.7000,
Basincss and I+masarm,cane:The Commcmr'w License Law does no,apply to an Required Inspections
siw emprupenr vin leveNuildi .., a h does. h tended S1F�-•c-?'F-I'NALt,-HU;ICD I'.IVG'
r nu„ n sal .I,e cided in., 1 l I intended oe
offered for vile If,e c cru the building nen a Int . Lod he did Inc ycv of {"-"_1
mwro,e far me w%e of uildcr will have the burden of Proving that he did not hold or
pmre res PUHsose ur vide.).
❑I,as owner onbe Properly,t i esrheimly romra,ia,wire licensed r onemrs to '
cnna ret the Project(See.7144,Business and Professions Ccdc:)*no ComremorY �� .
. License Law docs nal apply man ovine,ofpmpnty who builds or improve.•(hereon. �,� rs�a
and who comrads for such pnfjecs with masons)licensed pursuant to,he rN teat
Commmaorw Licenw Law.
❑1 am exempt u B&PC for this reason APR 2 3 2002
Owner f 1 a. .
1 OReEk' C(.11'ENSIO
AT ,DECLARAI'ION -
1herebydBred under penalty of perjury one ofhe followingdecloodons. BUILDING
Cl 1 hart and will maintain a Cenifcme of Comore to self-insure for Worker's
Cnmpst,wion, as provided in, by Section 3700 of the labor Code, by the
Performance of the work for which this Permit i.,issued.
EI 1 have and will nicaro m Worker?Compensation Insurance,as requited by Section
1700 of the Labor Cale,lin the Pfation rm of the work for which this permit is
cued.My Worker's Cmnpensation b,sw'ance carrier and Policy number arc: '
Carrier: Policy No.: ,
CERTIFICATION OF EXEMPTION FROM WORKERS'
Co MPIINSATION INSURANCE,
(I his section need net be completed it the ,.it is c,one handled dollars
(Mol)or lcrod
1 comfy the,in Ie Ierfonnoom of the work for which arts pe.mil is i...ed,1
shall oat employ any Person in any manner so as to become wbject to the Workers
Cr... esu non laws of Caliburria.Dula '
Applicant -
N'O'I'ICE TO APPLICANT:ICaller making this Cenilicme at Exemption.you should
became subject to the Workers Compensation prnrisinns of the Lder Cede,you must
z
0 Q
lonbwid,comply with such pravl.ionm
5 or his .it shall be decided revoked.
. .
F
CONS I FUC TIONLENDING AGENCY
a } 1 Mmar ultinn This tlmrc is u c..cd(Sec. (coding egmocy aur the pofomwme
nl the work for which his met is i.rued(Sec.iPN].Civ.C.)
Iw Name
z I-scnru dcr's Address •
I cram y that I base read his opphemion cad well,that the shove n urmmian is
[.w correct.1 agree m comply with all city and comity ordinances and.state laws relating
0 C1 to building cooaruoinn,and hereby aohorireu,orenlativennfthiw city to enter Or i
} �] the above-na:miooed pmPny'far imP:ction pm,see, '
F, 4. (We)agree msavc, ndcmnify: d keep burmlewme Citym Cupcoinu.,clow
Zi liabilities.judgments.costs and expenses which may in any way accrue against saidCry 1.
C.) 9 6P CANT NDER reencen ares S AND ILL CO
1 of 1
MPLa'WITH ALL NON-POLY('
RCE r1jlLAnorvs: Issued by: .Date
Si �) ,h ,m', nn Date Re-roofs
HAZARD( S h1A'rGR1ALs DISCLOSl1RF,
Will it Pplieanl m ra are buudhg acapam Brom arhatdle havalloas mamrial Type of Roof -
asdefnedbyJM1eCuprninn Ictpal Cede Chapmr9.12.,dhc Hrdm and scary
Ctdc Section 25532(x)?
)Yes El No
All roofs shall be inspected prior to any roofing material being installed.
Will the xppbcam sir enure burro,)col„mall,egdpe.eal ordeviees which Ha roof is installed without first obtaining an inspection, I agree to remove
emit hareNous air conmminanrs as refund by he Bay Area Air Quality Management
P g
Di.hia7 all new materials for inspection. Applicant understands and will comply with
0Y,, °no all non-point source regulations.
I hese read he Ramidnus n llel ala rcquironenta coder Chapter 6.95 or the
California Health&Safety Cada Sections 25505.25533 and 3534.1 understand that
inho building does not to...cndy uric a(anon.for n is my rc,pomilillity to notily be
occupant or the requirements tic amt he and prior to iovarm of n Cenifeam of
occupant at
/ Signature of Applicant Date
edowm - gen Dale All roof coverings to be Class `B"or better
OFFICE