02080116 CITY OF CUPEWHNO
BUILDING DIVISION PERMYI' CONTRACTOR4INFORMATION ='
Bmq g r�gyRNE AVENUE RJC CONSTRUCTION COMPANY PERMrrT2080116
`_' IJffA%U & CHI ZHANG 45973 WARM SPRINGS APPLICAEO)BsPPTTE2002
IONS, (510) 353-0588 SANITARY NO. CONIROI.NO,
ARCIII'rECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT
PLUMB MECII
0 t 0 0
EOp LICENSED CONTRACTOR'S DECLARATION
e w P I heresy alfirm that I am licensed under provisions of Chapter 9(commencing
2296 LVG. SPACEf p ob Description
NZw withSection70goofDivision3oftheBminessandP.Nesson,Code.andmYliccnsc
Og? License Class Lie
i F O Datc Contractor
As small fears DECLARATION' MAR 1 2004
1 understand my plans shall feared as PuM1lic records
U
X0
3 w y Licensed Pouleoronul
a, j OWNER exempt fr m the RATION 2 ,App pp����
<S 1 hereby affirm that 1 1. exempt from rbc Contractors License law for the _4tSI{S,I'I9Y
w Eno following rcaa+n(Scctinn]03 L5.Business and Professions Csxk:Any city or county
e x m� which requires a Permit to construct,alter,improve,demolish,or repair any structure
w—" prior to its issuance,atserequires the applicant(,it such permit to lilc asignedxutemeat
gra that he is licensed pursuant to the provisions of the Contractors License I,aw(Chapter 9 39g7EL21EI&BA6La Valuation
z.m (commencing with Section 7000)of Division 3 of the Business and Professions Gxlpor
a 3 our he u exempt therefrom and the basis for the alleged croupous.Any violation of
Section 703L5 by any applicant for a Permit subjects the applicant to a civil Penally of PN N Occupancy Type
nm more than nK hundred dollars(s500). 102 - PIERS
p y YP
O 1,as owner of the pro,serty,or my employees with wages as their sole compensation,
will do Ne work,and the structure is not intended or offered for sale(Sec.7840,Business ±e3 TJFER
and Professions Code:The Contractors License Law does not apply to an owner of 104 - REBAR Required Inspections
pr.Peny who builds or improve thereon.antl whotloes such work himself.,rhmugh his
ownemployces.Provided that such impro.2mcnuare nmintended confirmed(.,sale.If. 105 - ANCHOR BOLTS
however,the building or improvement is sold within one year ofcomplcrion,the.wner- 1O6 — SEWER & WATER
builder will have the burden of proving that he did not build or improve for purpose of
°) 202 - UNDERFLOOR PLUMBING
.as owner of the property,am exclusively conuanning with licensed contractors to 203 — UNDERFLOOR MECHANICAL
ennswn Ne project(Sec.]000,Business and Hofessions Code:)The Cuntranor's Li-
reLaw does not apply to annwnerofproperty who builds orimproveatherco a' 204 - UNDERFLOOR FRAME
LmenentreWts for such projects with a contract.rts)Eccn.ed pursuant th
no e Contractor no
205 - UNDERFLOOR INSULATION
C ,
am comm,(order Sce. ,B&PC(nt In.,..an 301 — ROUGH PLUMBING
L302 — TUB & OR SHOWER
WORKER'S COMPENSATION DGCLA 303 - ROUGH MECHANICAL
I hereby affirm under Penalty of perjury one of the following declarations: 304 - ROUGH ELECTRICAL
0 1 have and will maintain a Certificate of Consent o vols-insure for Worker's Compen-
sation,as provided[or by Section 374 of the Labor Code,for the performance of the 3 05 - FRAME
work to,which thi.......aisaue& 306 - HOLDOWNS
0 I have and will maintain Worker's Compensation Insurance,as required by Section 3 07 — INSULATION
37flM of the Labor Code,for the Performance come work for which this Permit is issued. 308 - SHEETROCK
My Worker's Compensation Insurance carrier and Policy number are:
Carrier Policy No.: 309 — EXTERIOR LATH
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE 310 - INTERIOR LATH
mrsaredon rmedmor the competed l(th,pemit is furore hundred dollars SI01) 311 - SCRATCH COAT
,it less.) 313 — ROOF NAIL
1 certify mat in the Perlin once of the work(or which Ibis permit is issued.1 shall not 501 - FINAL ELECTRI CAL ENERGY
employany persmt asrersn s ecu.the W.rkcri Cnmpcnsainn
Law.of Rm,mi 'i iiX7`o '_ 502 - FINAL PLUMBING ENERGY
NP TO APPLICANT If,after making this Cenifiea�fExemption,you should 503 - FINAL MECHANICAL ENERGY r
become Subject to the Workers Compereation previdons of the labor Code,you must 5 04 - FINAL BUILDING ENERGY
O O forthwith comply with such provisions or this permit shall be deemed cracked.
zCONSTRUCTIONI.ENDINGAGF.NCY 505 - FINAL ELECTRICAL
r_ N I hereby a0irm that them is a construction lending agency Ev me Performance of 506 — GAS TEST
a >
the work iorwhichthis permitiausued(See 309],Co,C.) 507 — FINAL PLUMBING
LL7 Q Len
dm's Nam.
Z LeneersAddress 508 — FINAL MECHANICAL
U O I certify that I nave read this application and slate that the above infomtation ts 509 - FINAL GRADE
F'
Correct.I agree to comply with all City and county ordinances and Sure laws.]arm,,. 5 FINAL PLANNING
nuilding construction,and hereby authorize representatives of oris city member upon the
above-mentioned Properly for inspection purposes.
�" (We) to save,indemnify and harmless the Ch of t 14 — FIN PUBLIC WORKS
( agree y an p y n Per iso against
F" � hard uitics,judgments,cases and expenses which may in any way accrue agam,said city 6 R O Y 00 NAIL
U Z in consequence ohne proof ng of this Permit. /
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by6 0 Date
SOURCE REGUI. NS. A 11
Re-roofs
awm a(App rcam/Contmnor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle harandous material
as defined by the Cupertino Municipal Calc.Chapter 9.12,and the Health and safety
ads.Section❑Yto
es 25532(a)'! Ism All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or m�r<wilding t,<•euPam nm ey.iPmem n,device.wni<h If a roof is installed without first obtaining an inspection, I agree to remove
emit hairmons air rontaminarts as dewed by the Bay Area Air Quality Management all new materials for inspection.
District?
c0 len
I have read the haraNnus mamnak myvimments under ChaplerflYS n(the Califor-
dialInot &ently haven ScNnns2at it
yrand255:41.1 and ntry to occupant
of ng
Jar not svrrmuly bout a tenant,that it is my responsibility m notify the tx'cupunl of Nc
reymrements come est ne met prior to issuance of a Cenificale or Occupancy. Signature of Applicant Date -
ser or anthorimd agent ate/L 2 All roof coverings to be Class "B" or better