05050145 CITY OF CUPERTINOu"+ w.e.�,� � '
BUILDING DIVISION PERMIT CONTRACTaR INFORMATION�-
BUILDINGADDRESS: SANFORD ELECT PERMIT NO.05050145
20902 GARDE
OWNER'S NAME: PERMIT ISSUE DATE
VINCENT LIU 20888 PROSPECT RE) 08/01 /2005
�E_ SANITARY NO. CONTROL NO.
(408) 996-9797
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby effrm Net 1 am licensed under provisions of Chapter 9(commencing P
U with Section]OW)nf Division 3af N=Business and Promolinm Code,eal my license is
? F n lull Tome and effect DEMO (E) HOUSE
J}p? Licenu Class Lic.Is
=Fp Dam Gontracter
ARCHITECTS DECLARATION
Sc rc I understand my plans shall M1=used as Public rcccoca
JyU
40t;; 1'ICcnSed P(11fC5a1nnal
3 OWNER-BUILDER< m DECLARATION I 1 hereby but
I am exempt from Ne.CConvenor's License Law for the
00 following reoson.(section 7031.5,Business and Professions Code:Any city or county
t m which requires a permit to conWuct.alter,improve,demolish,ar repair any swclum812000
e—'^ prior m its iouancc.also mqums the applicant for Such permit to file a signed statement
'RdonhealicemOdpurmaminamprovisionsofNeCOmvacee'sLicenntlsw(Chaper9 Sq.F[. Floor Area Valuation
YFp (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y $ Nat he is exempt demurrers and the hands for the alleged exemption.Any violation of
Section 703 LS by any applicant for a permit subjc,u the applicant to a civil penalty of p UU Occupancy Type
not mare than five hundred dollars(5500).
❑1,W owner of Ne property,or my employe=with wages as their sole compensation,
will do the work,and the s rmume is not rumored orofTend for sale(Sec.7144,Business
and professio=code:The Conaammrs License law aces not apply to in owner of Required Inspections
property who Wilds or impmma thetean,and who doessuch work himselror through his
own employe=,provided Nat such improvements the not intendeA oroRered forsale.If.
however.Ne building or improvement is sold within one year of completion.the owner-
Wildcr,will have Ne burden of proving Nat he did not build or improve for purpose of
s
7as owner of the property,am exclusively contracting with licensed contractors to
corvct the proper(Sec.7064.Business and Professions Cade)The Contractor's Lt.
count law docs not apply to in owner of property who Wilda or improves themon,and, \ ��
who contracts for such projects tr
with a conutor(s)licensed pursuant to the Contractor /
License law.
El I ore exempt under See. B&P C for this mason / \
Owner RS Doe 0 \\
WORKER'S COMPENSATION DECLARATION V
Ihmebyafrrm under penalty of Perjury one of the following dalatadonse
7031-
nam and will maintain a Cenifica,of Consent to selNinsum for Wolters Comfier-,az provided for M1y Sttuon J70o of the labor Code,for Ne pertormana of thefar which Nis permit isissued.have and will maintain Worker's Compensation Insurance,az required by Semon
of the labor Code,for the pcdormancc of the work for which Nis Permit is issued,
orker's Compesuadmn Insuranec carie'.and Policy number arte'.. Policy No.:
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This metr=o need not uncompleted If the Permit is for one hundred dollars(SIM)
nr lcssJ
1 eerdfv that in the performance of the work for which this Permit Is issued.1 shall not
employanypermninanymanrteUo to become suhjecuothe Workesi Compctwtion
Lawn of California.�4� Y D
Applicant' —
NOTICE subject
APPLICANT.IL after making this Provisions
n s Of m Exemption,you ushould
mot
become scoop y the WorkersCompensationenvisions of the Labor Code,you must
.JO forthwith comply with such provisions or this permit shall be a=cmcd revoked.
'� CONSTRUCTION LENDING AGENCY
[+� Ihereby affirm Nat there isoemnuructinn lending agency,In,the perfarmena of
!Y the wort for which this permit u issucd(Sec.3097,Civ.C.) -
aQ Lenders Name ,
=,z Lender's Address
U O 1 certify that 1 have read this application and sure Nu the above inf.OnAOn.is
ly H toren.1 agree to comply with all city and county ordinances and state laws mlating to
0U building convection,and hereby amhorim mpmsentatives of this city to enter upon the
} W above-mentioned property,for inspection purposes
H (We)agree to save,indemnify and kap harmless the City of Cupertino gai=t fajl Imbilitica,jatlgmcnts.costs and cxpcnms which may in any way amore against said City
U in consequence of the granting of this Permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Datep-
SOURCE REG AT�Jl, 1015�
�� l� Re-roofs
Signature lir ApplicaHO Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF ,
Will theapplicant or future building Occupant Chapter
ummorandhandle Health asmamrial
az Ocfin=d by the Cupertino Municipal Coo,Chapmr 9.11,and the N=IN and Safety
cw=.s❑timm255320n
Ye - All roofs shall be inspected prior to any roofing material being Installed.
Will thea applicant or rulum budding«mu amt use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
nP s P gaipm=n
Fir ba>ardous air conlxmimanta finod by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑secs No
1 have rtad the hvardrms materials requirementsunder Chapter 695 ofthc Califnr.
nix Health 5 Safety Code,Seedons 25505,15533 and 15534.1 understand Naz if de budding
Nes not currently have a mnam that it is my resporuihility,to nod I the Occupant of the
regmrcreentawhich most bcmet ph.,u,irsuanceofacertifiaeofOcXCy. Signature of Applicant Date
`�'`dag `� D.uc All roof coverings to be Class"B"or better
Owner or auNorisd agent Da¢