04040063 CITY OF CUPERTINO -fie. r.�e F°• w�' ' ?� .xf< >_'.§-'3`,r"'
BUILDING DIVISION PERMIT CON,'TRACTORaINFORM ATI ON
To- r,:�wRfn ., .4.xSf ib/ Y.Ff..'a 'e',; cXi y. :$•, s#!..
BUILDINGADDRESS: NICE & RIGHT CONSTRUCTION b""'.04040063
S30 CRFIRTON DR
NER'S NAME: PERMIT ISSUE DATE
MING CHEN 166 EUCALYPTUS F)R
NE: SANITARY NO. CONTROL NO,
(415) 239-2696
Cl UTECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMO M[CII
0 0 0
40, LICENSED CONII NACI'OR'S DECLARATION
F❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
iW with Section707(fiof Division 3 ofthe Businessand Profession,Cndeand my license is
ta„ in full force and effect. REVISION- -WINDOWS/ELEV
12 Z License ClassLic.p
It a Date Controcer NO NEW PERMIT ISSUED/ORIG. 403050018
ARCHITECTS DECLARATION
da I understand my plans shall IDI used as public records
JyU
S o N
Licensed Pndcssinnal
in S OatIam exLDERempt
DECLARATION
<S I hereby affirm that 1. eampl from the Contractor's License Law for the
_p0 following reasnn.(Secfun 71Y31.5,Business and Prufessint Code:Any<itym county
o w,r which requires a permit an
m cotour,alter,improve,demolish,or repair any structure
°jy prioriusismance.kan requires the applicant fur such permit it)Glc a.Ngmed statement _
a thatheislice nwdpursuanuothe provisions ofthe Cnmmcter'sLicenscl-owelopter9 Sq. Ft. Floor Area Valuation $0
yHpi (commencing with Section 70NI)of Division 3 of the Business and Professions Code)or
y $
that he is exempt therefmm and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollen($500). 32612060 . 00
p y Yp
1,as owner of the property,or my employees with wages as their soon compensation,
will do Ne work,and the suuaure is not intended or offered for sale(Sec.7W,Business
and Professions Cade:The Conmctor's Line Law does not apply to an owner of Required Inspections
property who builds or improves Ncfcon,and who doessuch work himself or through his
Own employees,provided that such improvements are not intended oroUered for sale.if.
however,the building or improvement is sold within one you of completion.me owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sate.).
1.as owner of the property,am exclusively contracting with licensed contractors to \�
construct the project(Sec.7844,Il uxincas and Professions Coi The Cummetm's Li
ecion Law does not apply to an owner of property who builds or improves thereon.and
who contracts for such projects with a sontranor(s)licensed pursuant to the Contractor's
License Law.
❑1`am�e njp r Sec. B&P C for this reason
}
< in Date
W R 'S COMPENSATION DECLARATION
I hereby of ren under penalty of perjury mte of he Follo/wsn'adoe,ladomns:
I hnve and will maintain aCertificate of Cnnsem m self•ir mfurWorker'sCumpen-
salad,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation insurance,as required by Section
37M of NC Labor Cook,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not tecompleted if the I ench is fmone hundred dollars F$Ki
or less.)
1 eenify Nm in No perf mormee of the work for which this permit is issued.I shall at
employ any person in any manner u M to become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifcate of Exemption,you should
become subject to the Worker Compensation provisions of the Labor Code,you must
.J O forthwith comply with such provisions or this farm iI shall be deemed revoked,
CONSTRUCTION LENDING AGENCY
I hereby affirm Nat mere is Construction lending agency for the pctfuttance of
O: the work for which this pencil is issued(See.3897,Civ.C.)
W Under'a Name
M, Lender's Address
oz
(�O 1 certify Nat 1 hate read this application and some that the above information is
U. ^F coned.1 agree to comply with all city and county ordinances and spite laws relating to
0U building construction,and hereby aunonie representatives of this city to enter upon the
r W above-mentioned property,for inspection purposes.
y (We)agree N save,indenmi fy and keep harmless the City of Cupertino against
FNliabilities,judgment,costs and expenses which may in anyway accrue against sant City
U z 5atuic
0c.nUCO
f this permit.
^ S AND 1 COMPLY WITH ALL NON POINT Issued by: Date
(or Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant Store or handle hmardous mamrial
defined by the Cupertino Municipal Codc,Chapter 9.12.and mM1c Health mJ Safety
rtic,soYes les 25532(a)y No All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building Occupant use equipment or&vices which
If a roof is installed without first obtaining an inspection,I agree to remove.
pp s P quintan
tinct? nus air cnmvminanuazrefined bythe Day Area Air Quality Mawgcmeot all new materials for inspection.
District?
C)yes ON.
I have real the hazardous materials requirements under Chapter 6.95 of ac Cahfor
niaHwllh& nyCtdc,Sccoons 25s()5,25533andzs534.lundcraond NatiflM building
does nnl c ra ha enanm,Wm itis DIY respunsihility m nobly the occupant of Nc
rcyuiu ni )(n u xme niaamancenracenifca nreapaner. Signature of Applicant Date
OAK,m prned est,
All roof coverings to be Class "B" or better