05110084CR
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
V?CUNTRACTORINFORMATI(QN qv
BUILDINGADDR SS:
0584 ORA VISTA AVE
D & D CONSTRUCTION
PERMIT NO.0 5 110 0 8 4
OWNER'S NAM11:
PERMIT ISSUE DATE
WEN JUN TANG
1447 HAMPTON DR.
02/13/2006
NE:
SANITARY NO. CONTROL NO.
(408)666-5298
GHITELTIENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
-
Job Description
1 hereby affrm that 1 am licensed under provisions of Chapter 9 (commencing
p
with Section 701fof Division 3 ofthe Business and Profcuinna Code,and my limmin is
in full force and Affect.
2-STORY SFDWL (3660' LIVING)
License Class L'=' 0
Dau Continuum-GARAGE-681'
ARCHITECT'S DECLARATION
I understand my plans shall he used ss public records
Licensed Professional
OWNER-BUILDER DECLARATION
Lie"se Law for the
i I hereby affirm That 11. exempt from the Comas
O following mtmn. Co
]nam demons Cade:Any city or county
,aineaand w, llmnuw
which sequins a permit re co"wet slug impmsu deermiti area sig
which Permit
ed
priormsJim-n nceatsantto the for wchp)tor's icese,Law taumem
Is isccenwit inion the era Law 9
l0th)of
Sq. Ft. Floor Area
Val i8f'a.
that punuent pro of
of
Division eBuuessand sCrue)
thDivision3 of ac B"In"a and
�(commencingwingenions it es. An hCode)ser
Net he u exempt mmfrom and dte bait for tie Waged tamption. Any violation of
APN Number
Occupancy
p y �YPe
Section 7031.5 by any applicant for A permit wbjeeu the applicant or a civil penalty of
nor mom than nae hundred dollars (g5m).
32608035.00
❑ 1."owner of the property, "my employe" with wag" As Neu cele compensation,
Required Inspections
will do the Mmk.and mommstues b last intended or offered Imitate (See 7044. Business
and Professions Code: The Contractor's Litt"e Lew do" not apply as an owner of
q P
property who bullds or improves slower, end who doessuch walk himml f ar through his
own employe", provided that well improvements are not Intended oroRered for We. If.
however. tie building or improvement Is sold within use you of wmpledon. the owner.
Wilder MR have the ancient of proving that he did not build or improve for purpose of
"Io.).
❑ 1, as owner of the property, am exclusively contrasting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's Li-
cense taw docs not apply as an owner of property who Wilds or improves demon. and
who contracts for snob pmjccho with aemnrraetar(s) licensed partner as me Contractors
License law.
,
❑ I am exempt under See .B&P C for this meson
/7 ..Dau
Ownerr "-�-
4.
.
p�'S COMP f9#FON DECLARATIONdft
1 hereby atrrm ander penalty of perjury am of be following decluation:
,1 haw And will main i in a CCABou of Consent malf-Insure for Worker's Compan-
thdom, As providW for by Section 3700 of the labor Cade. for the performance of pro
work for which this permit is issued.
❑ 1 haw and will maintain Worker's Compensation Insurance, As required by Section
3700 of the labor Cade, for the performance of the work far which this permit Is Issued.
My Workers Compensation Wunnce carrier and Policy number m:
Cartier. policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tim section need not becomplAn d If the permit Is for one hundred dollars (SIM)
or less.)
1 mru(v Nal In in. Parr .r e.sce of the wilt for which Nb permh is issued, )shall not
employ any permit In any ma"res u b becomewbjkc u the Work"", Compensation
Laws Califamla. Data
ca
Applicant Q
NOTICE APPLICANT: 1(alwr me g this Cisions a of Ea) prion. ore should
subject of the Labor Cade,. muss
becomeeh tic Worker's
oCompensationprovisions
forthwith comply with such provisions or this p)rmiuhell be deemed revoked.
compo
CONSTRUCTION LENDING AGENCY
I hemby affirm that Nem is. construction lending agency for the performance of
' the work fur which this permit Is issued (San. 3097. Civ. C.)
Lenders Name
,
z Lendet'aaddress
1 modify that I have mad this application and suss mm the abate inlmmatiun IS
Cowct I agree as comply with all city and county on inances and show laws mining to
building eonswnion, and herby wthodw repreanmim of this city to cnur up in me
ahave-mcntiorcd pmpCryfar Implodes PLAPML
yr (We) egme m nal, indemnify And keep harmless the City of Cupertino against
A Iiabiliti",judgments, costs and expenses which may In any way accrue against aid City
in consequence of me Prating of mis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date `2 �"� --� 0,
SOURCE REGULATIONS.
J
Re-roofs
Type of Roof
.,
ir/-- •�r /%'
Signamr o(AppliIifiCtinvotor
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle harmuus material
defied the Cu( Municipal Code. Chapter 9.12. and the Hcalm ad Safety
. SCNenby 13 53:(.)?
All roofs shall be inspected prior to any roofing material being installed.
❑Y" 11yvu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
t,muia?
:t huardous air con aminnu As defined by to Bay Arca Air Quality Management
all new materials for inspection.
,—✓
❑Yes LPN
I no. mad dse hese ousmawrials rry.immats under Chapteri950flhe Califon
Dia H"Im@Safety Codc.Socd"u355U3. W33 and 25334.1 understand mm ifine building
does net comedy haw a tenant that it w my responsibility An notify de occupant of N)
uquirmcnts which mum be met Judicial issuance ofa Centificau of Occup rr.
,Signature of Applicant Date
2ljzloK
All roof coverings to be Class "B" or better
Owner or sometime sent Diud