05060137 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR INFORMATION ".
BUILDING ADDRESS: PERMIT NO.0 5 06 013 7
10240 CALVERT AVE
fIE:
R'S NAME: PERMIT LSSUE DATEBIN WANG 10/03/2005 SANITARY NO. CONTROL NO.
ARCHIILCIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION lob Description
inI hereby affirm that Ism licensed under provisions of Chapter 9(commencing P
with Section 7Wh of Division 3.f be Business and Profeasions Cod..end my license is
7 „ in mumr.eandeffect. ADD 585 ' (LIV. /STUDY) &
,qi License Class
Dale CCami ADD 74 ' -GARAGE/CONVERT 132 ' GARAGE TO LIV.
DELL
As shall use DECLARATION
Sx a< I undersand my plans shall N used as public records
,nV
t G
Licensed Profcssinnal
g3
OWNER-BUILDER DECLARATION
in
9 P I hereby affirm Nat 1 am exempt form the Control License Law for the
00 following reason.(Section 713 1.5,Business and Profoxsiom Cale:Any city m country
i m which requires a permit to construct.alert improve,demolish,or repair my stmctum
pdonn its iuumee,alsu re quires the applicant for such permi Uo file a signed mooment
-�< that he is licensed pursuant to the previsions of Ne Conuaturi Limn.Law(Chapter 9 Sq.Ft. Floor Area Valuz$iff 000
yF$ (commencing with Section 7000)of Division 3 of NC Businessand Profvsiom Code)or
y _
that he is exempt IMrcfrom and IN basis for Ne alleged exemption.Any violation of
Section 703 L5 by any applicant for a permit subjects the mplicanno a civil penalty of APN Number Occupancy Type
ret mom Nan fi,M hundred dollars(S50o). 37518022 . 00
❑Las owner of the property,or my employee with wager as their train campen.tion,
will dis the work.and the swctme is not intended or offered for safe(Sec.7014,Business Required Inspections
and Professions Code:The Contractor's Liaise law does not apply In an owner of q P
own enywhp Nies providd than suchonhaves improvements and
doeuuch worktende himself
eedthrough his �� ����
awn employees.carhebuilding
provided than such impro old wit arc not es,of d or offered for sale.If.
boildic, Neave far tar den ofpm.ntissoldwithinone yeti of completion.the..on
of
builder will Mere IN burden of proving Net N did not Nib or impmw for purpose of
tale.).
�yari� m owner of Ne prop.ny,am exclusively convecting with licemed contractors to
MCI the the pmjen(See 70C4.Business and Professions Cade:)The Contractor's Li. J� 29 ?lies
come Law does not apply to an owner of propeny who builds or improve Worth,and •a
who contracts for such projects with a contractor(s)licensed pursuant to the Comracte is
LeenLaw. WILDING
❑I am exempt under Sec. .B k P C for this rtaspa
137Ms X�IO - Data �Q -
- W00. ER'S COMPENSATION DECLARATION
I hereby aRmt under penalty of perjury,one of the following declarations:
have and will maintain stCenificure of CO..,b self-insurt for Wmker'4C..Nn-
,as provided for by Section 3700 of the Labor Code,for the afformancc of the
for which this p:non is iasned.
have and will maintain Worker's Compensation Insurance,as required by Section
ofthe Labor Code.for Ne arfarmnce ofde work for which this pcmn is issed.
orker's Compensation Tnsurs..carrier and Policy number are:er, Polity No.: _
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
(Thu.ction recd not N completed if be permit is furane hundred dollars(SIM)
nrlcas.)
I cer ify that in the perfo thane of the work for which this permit is wood,1 shall nut
employ any Nixon in any manner so as in NeOmc 'ccU. ri COmpensation
Laws
of Caliromia.0 t2c OO_.t
Applicant "5+to ->— TT
NOTICE TO APPLICANT:IL after making this Cci ificaa or Exemption.you should
become subject to the Worker's Compensation provisions of the Ichor Code,you must
OZ foMwith comply with such provisions or this permit shall N deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-..� I hereby affirm that there 4.cotsvucfion lending agency for thin performance of
rYIN work for which this permit is issued(Sec.3097 C'v Com—`
Lu AUndoes Name
G. Lender's Addm_cs '
a Z
U 0 1 certify Nat I have read this application and stain Net the shove information is
u, f-' comecL I agree to comply with all city and county on imams and sate laws relating to
0 U building Construction,and hereby auNpPoe representatives of this city to enter upon IN
r W shove-mentioned pmpcny for iepcmon pimpmot.
F t1 (We)agree to save,indicmrefy and keep harmless the City of Cupertino against
(/3 liabilities,judgments,cola and expenses which may in any way accmc against mid City
U Z APPLIC NTeof the UNDERSTIing of ANDSIbis AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (�� 0
SOURCE REGULATIONS.
Re-roofs — -�4
Signamreof ApitlicanVCansacmr D m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicent or ran.building occupantnoon or handle inm us mmerial
as defined by the Cupertino Municipal Code.Chapter 9.12,and IN Health and Safety
,djIfte. aim 25532(a)7 -ATI roofs shall be inspected prior to any roofing material being installed.
❑Yes ANo
Will the applicant or future building oaupant use equipment or device whim -If a roof is installed without firs[obtaining an inspection,I agree to remove
mit ha"ardous air contaminants as dcOned by the Bay Area Air Quality Management all new materials for inspection.
Dixvict7
❑You;
1 have mad the havartlons materials requirements under Chapter 6.95 of the Califor.
ni.Health h Safety Cade,Scedas 25505.25533 and 25534.1 undersand Jut if the Wilding
does ret curmmly have a Moan.Nat it is in,repomibility no notify do acupmt of the
requirements whim must N met priorm issuutceofa ccruRcaeof Gc. er.o Signature of Applicant Date
/o
Owner oraumonvedagent Date All roof coverings to be Class "B" or better L=
CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR INFORMATION ".
BUILDING ADDRESS: PERMIT NO.0 5 06 013 7
10240 CALVERT AVE
fIE:
R'S NAME: PERMIT LSSUE DATEBIN WANG 10/03/2005 SANITARY NO. CONTROL NO.
ARCHIILCIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION lob Description
inI hereby affirm that Ism licensed under provisions of Chapter 9(commencing P
with Section 7Wh of Division 3.f be Business and Profeasions Cod..end my license is
7 „ in mumr.eandeffect. ADD 585 ' (LIV. /STUDY) &
,qi License Class
Dale CCami ADD 74 ' -GARAGE/CONVERT 132 ' GARAGE TO LIV.
DELL
As shall use DECLARATION
Sx a< I undersand my plans shall N used as public records
,nV
t G
Licensed Profcssinnal
g3
OWNER-BUILDER DECLARATION
in
9 P I hereby affirm Nat 1 am exempt form the Control License Law for the
00 following reason.(Section 713 1.5,Business and Profoxsiom Cale:Any city m country
i m which requires a permit to construct.alert improve,demolish,or repair my stmctum
pdonn its iuumee,alsu re quires the applicant for such permi Uo file a signed mooment
-�< that he is licensed pursuant to the previsions of Ne Conuaturi Limn.Law(Chapter 9 Sq.Ft. Floor Area Valuz$iff 000
yF$ (commencing with Section 7000)of Division 3 of NC Businessand Profvsiom Code)or
y _
that he is exempt IMrcfrom and IN basis for Ne alleged exemption.Any violation of
Section 703 L5 by any applicant for a permit subjects the mplicanno a civil penalty of APN Number Occupancy Type
ret mom Nan fi,M hundred dollars(S50o). 37518022 . 00
❑Las owner of the property,or my employee with wager as their train campen.tion,
will dis the work.and the swctme is not intended or offered for safe(Sec.7014,Business Required Inspections
and Professions Code:The Contractor's Liaise law does not apply In an owner of q P
own enywhp Nies providd than suchonhaves improvements and
doeuuch worktende himself
eedthrough his �� ����
awn employees.carhebuilding
provided than such impro old wit arc not es,of d or offered for sale.If.
boildic, Neave far tar den ofpm.ntissoldwithinone yeti of completion.the..on
of
builder will Mere IN burden of proving Net N did not Nib or impmw for purpose of
tale.).
�yari� m owner of Ne prop.ny,am exclusively convecting with licemed contractors to
MCI the the pmjen(See 70C4.Business and Professions Cade:)The Contractor's Li. J� 29 ?lies
come Law does not apply to an owner of propeny who builds or improve Worth,and •a
who contracts for such projects with a contractor(s)licensed pursuant to the Comracte is
LeenLaw. WILDING
❑I am exempt under Sec. .B k P C for this rtaspa
137Ms X�IO - Data �Q -
- W00. ER'S COMPENSATION DECLARATION
I hereby aRmt under penalty of perjury,one of the following declarations:
have and will maintain stCenificure of CO..,b self-insurt for Wmker'4C..Nn-
,as provided for by Section 3700 of the Labor Code,for the afformancc of the
for which this p:non is iasned.
have and will maintain Worker's Compensation Insurance,as required by Section
ofthe Labor Code.for Ne arfarmnce ofde work for which this pcmn is issed.
orker's Compensation Tnsurs..carrier and Policy number are:er, Polity No.: _
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
(Thu.ction recd not N completed if be permit is furane hundred dollars(SIM)
nrlcas.)
I cer ify that in the perfo thane of the work for which this permit is wood,1 shall nut
employ any Nixon in any manner so as in NeOmc 'ccU. ri COmpensation
Laws
of Caliromia.0 t2c OO_.t
Applicant "5+to ->— TT
NOTICE TO APPLICANT:IL after making this Cci ificaa or Exemption.you should
become subject to the Worker's Compensation provisions of the Ichor Code,you must
OZ foMwith comply with such provisions or this permit shall N deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-..� I hereby affirm that there 4.cotsvucfion lending agency for thin performance of
rYIN work for which this permit is issued(Sec.3097 C'v Com—`
Lu AUndoes Name
G. Lender's Addm_cs '
a Z
U 0 1 certify Nat I have read this application and stain Net the shove information is
u, f-' comecL I agree to comply with all city and county on imams and sate laws relating to
0 U building Construction,and hereby auNpPoe representatives of this city to enter upon IN
r W shove-mentioned pmpcny for iepcmon pimpmot.
F t1 (We)agree to save,indicmrefy and keep harmless the City of Cupertino against
(/3 liabilities,judgments,cola and expenses which may in any way accmc against mid City
U Z APPLIC NTeof the UNDERSTIing of ANDSIbis AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (�� 0
SOURCE REGULATIONS.
Re-roofs — -�4
Signamreof ApitlicanVCansacmr D m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicent or ran.building occupantnoon or handle inm us mmerial
as defined by the Cupertino Municipal Code.Chapter 9.12,and IN Health and Safety
,djIfte. aim 25532(a)7 -ATI roofs shall be inspected prior to any roofing material being installed.
❑Yes ANo
Will the applicant or future building oaupant use equipment or device whim -If a roof is installed without firs[obtaining an inspection,I agree to remove
mit ha"ardous air contaminants as dcOned by the Bay Area Air Quality Management all new materials for inspection.
Dixvict7
❑You;
1 have mad the havartlons materials requirements under Chapter 6.95 of the Califor.
ni.Health h Safety Cade,Scedas 25505.25533 and 25534.1 undersand Jut if the Wilding
does ret curmmly have a Moan.Nat it is in,repomibility no notify do acupmt of the
requirements whim must N met priorm issuutceofa ccruRcaeof Gc. er.o Signature of Applicant Date
/o
Owner oraumonvedagent Date All roof coverings to be Class "B" or better L=