06010047CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT N0.0 6 010 0 4 7
10428 S FOOTHILL BLVD
NER'S NAME:
PERMIT ISSUE DATE
GARY & DAPHNE LIU
02/03/2006
NE:
SANFARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
o
1 h)mby affirm Nal 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division J of the Business and Profwiou Code, And my license is
in full tome and.ffesh
License Class Y
FOUNDATION REPAIRMENT
o no
Conover
ARCHI DECLARATION
I understand my passe use shall he used u public rtcnrde
l/ /
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby .(firm Nat atIAm exempt from the Convenes License Law for the
following meson. 1. esu Cade: My City or county
Business mpr
dcmolh sig
improve. e stmcture$9000
which requires ! permit co str aikh demolish.ri
re cares
nt fmw,
prior m its Issuance. alta requires the applicant for such permit b Ole �lgae(summent
Also the t e A ed
Ft. Floor Area
Valuation
he of aucCBusinuhLcensemon(Chapter
pSecdm70the
Sq.
(but
commencing with of Division Code)
(commenting with Session 7000) of Division J fifth) Bualnw and Profcuiom CnO) or
that he is exempt therefrom uW the bah for door eticgcd exemption. Any violnlon of
r
Occupancy Type
Session 703 L5 by any applicant for! permit subjects me applicant b a civil mouthy of
nal ream man five hundred dollar! ($300).
❑ I, u o-xner of sire pmpc y. w my wploycu with wm u dxb wle emmpew0en.
ns
Required Inspections
will do Newark, and the structure itnminsendedmofremd mrule(Sec. 7044, Business
and Pmdot be, Code: The Commune, License law dbel apply b an owner of
e 9 P
property who bui ldt or im Proves themon, eM who does such work himsel f or through him
Own wmwtsin not fa
ountlWOraBered
hawew, the newer.
improvement it said within amyouhave.for the owner-
however. me Wilding or Improvement is
Ang
ED
u
builder will haw sire burden of poWng Wt he did nes build m improv for purpose of
ow
L
�'��®
tel).).
❑ 1, u Owner of the propmy, !m exclusively contracting with licensed connum ma to
Businessand Professi0u CWe:) The Conmev's Li.
consumer the project (Sec. 7044, Business
f�
JUL 1 q 2000�Qj
came w does not apply an mum, of propeny�whmvea o builds or impLemon, and
lab n
who contracts for such pmleeL with aCMtractm(t) licensed pursuant be the CogBbbrt
nce
Licelaw.
1g
I am esempt undo See. ,B k P C for this won10m
11fir-1A
Dek 7--3 – V 6
BUILD
net —
BR5 COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 h[wlad WBI meinYlaeMiBLlle of GOntCalbaelf-ImWe fnr WnikCttegllp)n-
motlon. u provided for by =on 3700 of the labor Code. far she performance of the
work for which this permit Is tuned.
,
❑ I haw and Will maintain Waaw's Compensation Insurance, As acquired by Section
3700 of the labor Code. for the performance of the wodr for which this permit is Issued.
'
My Workefa Compensation Iubance earner and Policy number see:
CamenPolicy No.:
CERI3FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section ncetl not he completed i(the permit is foram hundmddollw (5100)
or less.)
1 certify that in the performance of We work for which this permit is Issued, I Nall Out
employ anpperbn In any manna b Xb b xc%: subjtct to LIC Wonted CompewtiM
Laws of CalifAMIL Date 6
,
Applicant
NOTICE TO APPLICANT: IL after making this CcniOc.m of Exemption. you should
become subject in, the Worker', Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this permit hill be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby alfrm Out them is! constructions lending agency for she perfwmaue of
tie wark for which this Persil h lured (Sec. 3097, Cih, C.)
Lender's Name
,
Lender's Address
1 certify Nn 1 haw read this 1pp0ealion and tuts that the shave information h
Comm 1 agree in Comply with all City and county ordindnes Audi talk law missing in
Wilding conswction, and hereby summon mpresonutives of this city bent upon ma
.hew-memioned property for inspection purpmes.
(We) .grm Ice sew, indemnify and keep harmless the Chy of Cupertino ifumst
lubllmes, judgments, costs and expenses which may in any my accrue against Amid City
In consequence of me granting of this per it.
APPLICANT UNDERSTANDS, AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 2
SOURCE REGUUTiON
Re -roofs
i • 3
ak
Si rrear acatlVDr Dow
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willy applicant or forum building meupant samer or handle md
Saety
Health
defined by sihe Cupertino Municipal Code. Chaplet 9.@. AM the Health !fid Safety
u t 9.1
°°e•seCRm W32u)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
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
It huamnu air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
District]
❑Yue ON.
IhavemW theha7udaummadaitm4uimmenuunderC7upkr&95o(LheCelifor-
AI. Hulth& SafetyCode, Smicu23505.25533 W M5N. i neddtund audition building
7c
dao an, currently Mw a um4m Net It is my empomibilhy in redly me Occupant of the
mymremew Whie fpder®iAmaana ar.c)nin)ak or occopancy.
Signature of Applicant Dale
s 2– 3 `6
All roof coverings to be Class "B" or better
Ownek� rM.go. t O�Ic
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