02100127 CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT CONTRACTORtIINFORMATION
• BUlfpa4'@9uBYRNE AVE RJC CONSTRUCTION COMPANY PERMIT N02100127
OWrB11 dAh&, ZHANG XU 45973 WARM SPRINGS APPLICATITVY!""2002
HONE: (510) 353-0588 SANITARY NO./ / CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
1-00 LICENSED CONTRACTOR'S DECLARATION .IOb Description
a u 1 hereby aflirm that 1 am licensed under provisions of Chapter 9(commencing TEMP POWER P
t�dro w11hSection 71MkB of Division 3oflne Business and Pn,fesx dv, Jmylicenw is
FOy in full f�rsas�c a��nd effen. �[� yn ftp
M? Liccnsc:L:4,1 C Co-
/_fL0 S kl
F? w Datc I .O z Coin lar to
// ARCIIITECI'S D8 Ano O�
�a¢a 1TSfidcrsland my plans shall M used as public records n t' .S I,O�
MuMu 2 J LU
LL C y Licensed Pro e,sional
3 OWNER BUILDER DECLARATION
aS 1 hereby affirm that 1 am exempt from the Contractor's License Law for the BUILDING $200
ea 00 following reason.(Section 7031.5.Business and Professions Code:Any city or county
aadd'm which mquires a permit to cumtrucl,alter,improve,demolish,or repair any structure
F_y Poonoi11 issuans..a1surequi.sLW.'PI1.m for such Permit I.file a signed statement
< that he is licensed pursuant to the provisions of the Contractor'.sLicense Law(Chapter 9 3Sg7H1210QlL*A&& Valuation
a1- (commencing with Section 74U))(it Division 3 of the B usioess and Professions Code)(it
a 3$ that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
section Il31.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not more than five hundred dollars(S5(kn 304p NROUGH ELECTRICAL
Occupancy Type
0 1,as owner of the property,or my employees with wages ss their she cnmperbattort,
will do the work,and the structure is not intended or offered for sale(Sec.70H4,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
pmpedy who builds or improves thereon,and who does such work himselfor through his
Own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or improve for purpose of
saicJ.
0 1,as Owner of the property,am exclusively contracting with licensed convectors to
cortsuuct the project(Sec.7Ba4,Business and Professions Code:)The Convector's Li-
cense law docs not apply to an owner Of property who Wilds or improves themm,and
who contracts for such projects with a contractors)lice ¢d pursuant to the Contractor's
License Law.
0 l am exempt under Sec. ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affim,under Penally of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 37W of the labor Codc,for the performance of the
work far which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3708 Of Ne labor Code,fill be Performawe of be work for which this Permit is issued.
My Worker's nCn��O�nsali-onn lnsurane avier and Policy number 'd
Ca 'r��Nlt HA(t� Policy
ERTIFI ATEOFEXEMPr10NF RKERS'
COMPENSATION INSURANCE
(This section need nm N completed if the pclmu ix for one hundred dollars($10)
nr less.)
1 certify that in the Performance of the work far which this Permit is issued,l shall not
employ any Person in any manner so as to become subject o the Workers Compensation
Laws of California.Date
APpfcant
NOTICETO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mast
O z forthwith comply with iw'h provisions or this permit shall k deemed mvoked.
z O CONSTRUCTION LENDING AGENCY
F I hereby allirm that there is a construction lending agency lir the Performance of
ai the work for which this permit is issued(Sec.3(A7,Ci,C.)
W Udder's Nam.
G Lender'aAddress
oz
V 0 1 certify that I have read this application and stoic that the above inh oodiun ix
Li. " correct.1 agree In comply with all city and county ordinances and sate laws relating to
O V building conamction,and hereby authorire representatives of Nis city to enter upon the
above mentioncd rd".c costs
for inspection puratwhich ms
H y (We)agree to save,indemnify and keep harmless the City of Cupertino against
fn inconsequence enhe graving of this esmit, may in any way accrue againstsaid City
V z in consequence Of DE UNDERSTANDS
til this permit.
APPLI ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ( v
SOUR(X REG IONS.
!'� �p 1gaoZ
ig meof ApPicanUCnnlraaor am Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building occupanumm or handle hazardous material
ns defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)'I
0 Yea tarda All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant Or future building Occupant use a If a roof is installed without first obtaining an inspection, I agree to remove
PP g o pa o Air Qu lite Management
en g P
mit hazardous nil contaminants as ddined by the Bay Arca Air Quality Management all new materials for inspection.
District?
0 Yes )(No
I have mail the WsaNnusma¢rials requirements under Ch ipter6.95of the Calif o,
ilia Health&Safety Crsk.Sections25505,25533 and 25534.1 understand that if the building
doe not cuaemly hash a tenant.that it is my responsibility c notify the occupant of the
mquiremedlswhi On me,pear 1—isd:mce ofa Cmdiicom of a y Signature of Applicant Dale
z o2
nen Or a..br,. nt n„E All roof coverings to be Class "B”or better