06010021 CITY OF CUPERTINO
BUILDING DIVISION PERMIT rRACTOXINFORMATIONOA;
BUILDING ADDRESS: D Sc D CONSTRUCTION PERMITNo.06010021
0584 PLO VISTA AVE
OWNER'S NAME: PERMIT ISSUE DATE
..
WENJUN TANG 1447 HAMPTON DR. 02/13/2006
aC
NE: SANITARY NO. CONTROL NO.
(408) 666-5298
HITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
306 LICENSED CONTRACTOR'S DECLARATION 1bDescrip hon -
1 hereby affirm Nn 1 am licensed under provisions o
of Chaplet 9(commencing
with Section 70(10)of Division 3 of the Business atd Profusion Code,end my license 0
n in fun cera and eDea DEMO (E) HOUSE
Z Licerue Class Lie.g
O t-, Dale Conimesor
e QQQ ARCHITECT'S DECLARATION
e I undemand my plans shall he used u public records
J
k0 Licensed Professional
ZO3 OWNER-BUILDERexemptDECLARATION
O hereby affirm Net 11. exempt form Nc itatins Co License c Law co tie
ZOO o following recon.LScel,t 7031.5.s5.B, Itaa and improve,
de Invitations Cade:Any dry at county
$ti which requires•issuance.Alin re construct,plot,Improve,h Permit u m erepairsig ed strucdule $12000
_ZSA hiormisensedal paramount to
the the
rovisa applicant for sucConnetoitmfie .Lawdnnemcm
x�$< (com incing ithSection7 NcpmvivonafoxConmctarindProclajw(C ode)9 Sq.Ft. Floor Area Valuation
Met M Is exempt Section 7000)of theDivisionaifor the
alleghe ed
exaandon.Any
Code)or
Q�— that he 4 exempt Nmrtfrmn and Um bash for Ue alleied emmption.My violation of
Section 7031.5 by any applicant fora permit ubjecu the applicant to a civil penalty of
not am than five hundred dollar(5500} r Occupancy Type
❑Lssownmof thepropcny,mmy moplayees with waganUeh sole compewUen,
will do the work,end the atlYctu e is not intended or.flia ed(orssie(Sec.7044,Business
and Profession Cade:The Conhacmrs License Law dos not apply to an ownm of Required Inspections-
pmpeny who builds or imprevat ernon,andwhodoessuch work himselfor through his
own employes.provided that such Improwmenn are not intended moRerW for sal&if,
however.the building or improvement is Bold within one year of eempleuon.the amer-
builder ,will have the burden of preving Nu M did not Mid or Improve far purpose of ,w
&41 (\' < .
tom,u construct to p ej tie Sec.7 am ambrawly inews and eamessting with))Trued mmue, - O\
ueLa Neum not (Sec.7044,Businessand Profad on Cade:)Thews Income,
LI-
teow Law does not apply je an owner ofanc any who builds or improves Demon,and \�
whocontractsLatta for such projects with aamemmr(q licensed pursuant m the Cmmmora
License Law.
❑lam exempt undo`Sx B&PCfor this reason
Owner ION Dam 2 O b
UERSCO �NSATY M '
DECLARATION
I hereby of ice,under penalty of perjury one of are following declantiard:
1 ban and will maintain.Candlemas of Content mlf-tnmm for W fte.Compcn-
73700
nn.u provided for by garden 3700 of the labor Cade,for the performance of the
k far which this permit is ismed.
1 have and will maintain Workers Compensation Insurance,as mquimd by Section
of the LaborCdc,I"Ne perfennumccof the wart fa which Nu permit is issurA.
Workr,Campnaation Wunnce tartlet and Policy number art:
rier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu lection need nothecomplemd lithe permit is(mane hundred dollars T$IW)
or less.) ,
1 unify Nat In the performance of the work for which this permit Is issued.I chap not
employanypermninany7;m become subject m U¢WorkcW Compensation
Laws of California Dam =
Applicant
NOTICE TO APPLICANT:fr.after fliskird this Cen rjeme of Exemption,you Mould
become subject to the Worker's Compensation provWona of the Labor Code,you must
.,O forthwith amply with such provision or Nm permit shall he deemed revoked.
yn CONSTRUCTION LENDING AGENCY
F I hereby alRrm Nat Vert its convection lending agency for the performance of
ai the work fur which this permit Is issued(Sec.3097,Ci¢C.)
aQ Landers Name -
O Z Lenders Address
U0 1 emtify that I have mad this application and mace that Ute above information Is
II,F contact.I agree to comply with all city and county ordinances and mm laws miming to
Or, building convection,and hereby audeorirz nepremnativea of this city to corer upon are
4TI above-mcmioned property for Inspection purposes.
y (We)agree to an.indemnify and keep harmless the City of Cupertino aSainat
rat IladhUesjudgments,toes and expenses which may in any way accrue against said City
U 7 in co emputoce of the granting of this permit
t� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (�
SOURCE REGULATIONS. _
2/pf3
/
+ ° Re-roofs
Signature of Applicend/Cmoment Das
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ue applicant or future building occupmt amrc or head[.hvardos mmeial
fd&efinumed by the Cupertino Municipal Code.Chapter 9.12,and Ne Haslth and Safety
Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
[I Yet pNu
Will the applicant or future Wilding occupam use equipment or di which If a roof is installed without first obtaining an inspection,I agree to remove
haadnus air contaminants u defined by Ne Bay Arte Air Quality Management all new materials for inspection.
id]
❑Yet Na
I haw mW the hmsMmsmmrialsrcquimmcnuunder Chapmr6.95 orate Califor.
nia Health&SafmyCada,Section 255(15,25533 md25534.I understand dim IfUe Wilding
does not carnally haw a amount,that It is my responsibility,in nudity the occupant of the
nopircencnu which mam be met prior 111 Issuance of a Certipclm of Occupancy,r 3 Signature of Applicant Date° Ali roof coverings to be Class"B"or better
Owner or eulho and,gam Dimg