06120061 CITY OF CUPERTINO - I s - r z `"
BUILDING DIVISION PERMIT CONT CA TmOR INFORMATION
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
7R YUNG CHEN 1585 TERMINAL AVE 12/22/2006
vE:
SANITARY NO. CONTROL NO.
(408) 499-0266
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
pQ LICENSED CONTRACTOR'S DECLARATION Job Description
U C 1 Wmpy affirm Nn I am fi c lid under provisions of CW Pmr Y(commencing P
b wiNSecdon]IXIU)afDivision3allheBusinevandProfessiumCade.andmylicenscu REVISION: MOVING 'WALLS AND PLUMBING FOR SINKS
H in full fora and effeet.
�qz License Cham Lice If ORIGINAL PERMIT: 06100156
F,o Dam Conlnelo,
f ARCHITECTS DECLARATION
i m 1 undcrsund my plana shall x used as public records
tyU
°Q Licensed Pmfcuional
5 Oat I am exempt
from
m Ce CmuraON
i f I marcetehy.affirenSect on I am uempl(mm the Cssions Co License:A.,c law for the
O O fallowing rcazon.Permit
t ]oarearXI Business and sae.demolish.
Code:Any city car county
$ whichrequires,its un permit re l ummucl ahec improve,demolish,ri repair any structure - —
:i<
prior mit isswncc.alw requires the applicant for such permit be 0le asigncJ sammenl
that he is licensed pursuant to the provisions of de Contactor.Llan taw(Chapter9 Sq.Ft.Floor Area Valuation
E r$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $600000
_ Nm he is exempt therefrom and the buss for On alleged eaemptlon.Any violation of
Section 7031.5 by any applicant for a permit subject the applicant to a civil penalty of A,r3T�t Number Occupancy
not more than five hundred dollms(5500). 35720026 .)ff Pane Y Type
❑i.uowner oflhe proprty.car my employee+with wagesu their sole compensation,
will do the work.and the susembe a main model oroRead rormle(Sec.]061,Busimess
and Prormdam Corse:The Conmc nes Linonx law does MI apply to an owner or Required Inspections
property who Wilds or improves Iherean.and who does such work hintelf car through his
own employees.provided that such improvements are not intended aroRemal formle.If.
however.the Wilding or improvements sold within one year of completion,the owner.
builder will have the burden of proving Nat he did had Wild or improve for purpose of
sale.).
I,as owner of the property am cacludvcly connecting with Hemead anuxtars he
construct the project(Sec.704a,Business and Profession Cade:)The Contractors Li-
ve law docs not apply to an owner of property who Wilds or improves theman.and
who convect for such pmjcm with a conaactoRs)licensed pursaena b the Commetoes
License law.
❑tem ext pt oder Se 4 ,B&PCfm is
Lev. Date
19 ORKER'SCOMP Ss LARATION
1 hereby+Ram under penalty of perjury one of the following declaaliom:
❑Iham aM will mainuioaCertifiam of Comem to self-imurtforWarkersCompn-
sxGan,as provided for by Section 3700 of the labor Code,for the Performance of the
wank for which this Permit is issued.
❑ 1 have and will maintain Workers Compensation Issuance,as regwrecl by Section
377 of Ne Labor Code,fer the performance of t e work for which this permit is issued. '
My Workers Compensation Imaantt.nier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectio,need Irotbecompleted if the Permit 4 forene hundred dollars($1130)
or les.)
I ccttifv Nat in the Performance of the work fm which this h is issued,1 shut not
employanyperminanyromtZxrembecome subjCLt Workeri Compensation
lawsafealif Date
NQf1CB'TO P A I* 7N
r.after makIng N pfion,you should
became subject to the Workers Compensation provisions of de labor Cada you meet
.J aZ forthwith comply with such provisions or this permit shall W clamed mated.
.za O CONSTRUCTION LENDING AGENCY
[-+ Iameby.M.Nmthea is.consuucunn lendingagency far the performarceuf
!Yi >
the work for which this permit is issued(Sec.3097,Cih,C.)
W� p Lenders Name .
D z Lender's Add.
U C) I certify that I have read this application and some Nu Om above information is
Fcorrect.I agree to comply with all city and county oNinancer and sate laws relating to
DU building consurbcoon.and hemby authorize representatives of this city to enter upon tW
H yabove mentioned proycrty for inspection puymac.
(We)agree to save,indemnify and kap harmless the City of Cupnino against
Uz IUColiuo,judgment,cost and expenses which may in any way aecme against said City
sequence.(0.granting of do""
t-- APPLICANT NDERST NDS AND WILL COMPLY ITH ALL NON-POINT Issued by: Date
SOUR E LATIO
2 Re-roofs
Si f IicanUCantactor nam
HAZARDOUS MATERIALS DISCL6r&E Type of Roof
Will Ne applicant or future building acc.parlatere or handle haumdous mamnal
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
adc.secy.25532(a)]
❑res All roofs shall be inspected prior to any roofing material being installed.
�kla
Will Ne applicantar future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit humolcur air commarmana as defined by Ne Bay Arca Air Quality Management all new materials for inspection.
District] sd�ra�
❑Yes �Mo
I have read the haxasde is mamriab myuitcmcnts t mar Chapmr6.95 of the Califor-
oiaHctlO&SafctyCedc,Sectimts25505,25533 and 25534.1 undersand thmifthe Wilding
5�ac,
nal cunt IIY ave a m ant.Nat it a my repo t ivy to ratify Om o¢upant of the
re a muss met pier
-3 a Certificate of cap
Signature of Applicant Dale
ar th edagant m All roof coverings to be Class"B"or better