03090214 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONT�RAC r�ORNT+„ORMATIO
BUILDING ADDRESS: ZHONGHUA CHEN & JIANPING Z 11111 NO03090214
OWNER'S NAME: PERMIT ISSUE DATE
ZHONGHUA CHEN & JIANPING ZHIJAN 09/24/2003
NC: SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Its,
LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby art,,.the,1 am licensed under provisions of Chapter 9(commencing
'.ib with Section7")of Division]or NC Busineas and Professions Code.and my license is
y mmnmreeapaerrea, DEMO (E) POOL
t Z License Class Lic.g
eFp Dem Cunwc,or
ARCHITECTS DECLARATION
K 1 understand my plana shall he used as Public rends
>yU
soy Licensed Pndcssi.nal .
S OWNER BUILDER DECLARATION
1 hmossa alarm then 1 1. cBusin from spr Canons Co c:Any ccense law Tor the
�Oo followWhich requires
Fetish,on.
Inane, Itcss and imprw,demolish.
Ca lc:Any city(it county
m whishits ..a ...Is.so conawn,alcor.improve,demolish,nr repair structure $3500
_iy pnonoitsissuance,also mquins theapplicem for sucM1 permiuohlcasigned xtatemcnt Sq.Ft. Floor Area Valuation
�0 than he is licensed pursonnuo the provisions of she Contractor's Limnos Law(CWpmr9
2� (commencing with Smtlan7M)of Division 3 of the Business and Pefixems Cud.)or 36936039 . 00
$
that he is exempt therefrom and the basis for the alleged eremption.Any violation of
,Section 7031.5 by any applicant ser a permit subjects the applicant to a civil Penalty or APN Number ._.. Occupancy Type . .
not more than five hundred colla.(160)).
❑1.. net of de progeny,or my employees with wages ss their sole compen.tlon,
will do the work,and the structure is not intended or offered for sale(Sec.]044,Business Required Inspections
and Pmfesu'om Code:The Conaactur,License law docs not apply to in owner of q P
propel who builds mimprows thereon,and who dmaauch work himself or through his a
own employees,pmvidcd,hat such improvements are no,Mucrided or offered far I,.If. 11_
however.the building or improvement s sold within one year of completion.the owner. aa,
Witter will have the burden of proving that W did not Wild or improve for propose of "Vw
sale,). 7/
I,as owner of project
pmpcl,,B uclusivnd contracting witht)The
mnaamors I 1/
me La des not(See.n a4, nems and Profusions Code)The Convxmrs Lid
Genu law dose not apply je an owner of property who Wilds or impmvu thereon,and,w. /
who 4'...acts for such projects with v mmnnor(a)licensed pursuam to the Commeofa
Q 1 am exempt under cd. B A P C for this..an s�
Od(w
WORKER'S COMPENWAn0N DECLARATI
I hereby Jfstm under penalty of perjury one of cite following declarations:
1 haw and will maintain a Certificate of ennsenuo self inose for Workcr'a CUmpan-
sation,u provided ren by Saint 3700 of the Ialwr Code,for de liesfmmmm of Me
work for which Nis permit is issued.
❑I have and will maintain Worker's Ctumpen{ml0n Insunnec,a required by Section
3]00 of lie labor Code.for the perfomr.om or the work far which Nis pcmrit is issued.
My Wo,kefe Compensation Insurance carrier and Policy number am:
Cerner: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Misleads,need OR W comp ca d if the permit is fortune hundred dollars($100)
Ur Icsx.)
1 certify Nat in use performance of the work to,which Nis permit is issued.I shall nus
employ any person in any manner s,asm W.00e Subject o the Worked Compeuation -
Laws of Caliromia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cenifimm or Eacmp,ion,you should
become subject to the Worker's Compensation previsions of the Labor Chile.you must
D�, forthwith comply with such pmvishm s or this permit shall W dcemcd mwked.
zO CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the icrformanm or
�4 > the work fur which Nu permit is issued(Sec.3097,Co.C.)
'il.Q Lender's Name
1 Lcndnes Address
z) Z
J 0 1 certify that I have read this application and sum that the shave informaniun is
burtcin 1 agree to comply with all city and county ordinances and sum laws relating m
nd hereby do
buildingconstruction.S ti toaw.ind...if,and representativesofNiscity mertim,upon
ga Ne
J+ � ahovomcatiuned property for inspection purposes.
(s ju S.to sew,indemnify and kith hay in an the City of=against=against
� N
liabilities judgments.ease and oncoses which may in any wry amrm quina nid City
Z
in APPLICeUNDERof the granting of' D his TWILL COMPLY WI L NON-POINT Issued by: Dale
ANTSTANDSANAL
50 RCE REG U�LATIyNS.
V` Re-roofs
Si um of Applion anuacmr Date Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant.,future Wilding oceup.m.we:or handle haxac oust material
as defined by she Cupertino Municipal,Coda Chapmr 9.13,and the Health and Safety
Cale.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
p Yes N49u
Will the applicant or future Wilding meapaM use equipment or devims which If a roof is installed without first obtaining an inspection,I agree to remove
mit havasdous air contaminants as defined by the Bay Area Air Quality Mangcmcns all new materials for inspection.
District? .
QYu QQds
I have mW the bacaNuus materials requirements under Chapter 6.95 orde Calirm.
pia Health A Safety Code,Sections 25X)5.25533 and 25534.1 understand thmifte Wilding
reufro,i tl aveaenank Nmi,umy ..f.cvrilmnotify themcupant of Nc
myvimmcnts ah seas Wmct noon.issuance tuts CcrtiBcam oftxmpancy. S Signature of Applicant Date
��� ��/ All roof coverings to be Class "B" or better
owner.,suthoriuJu cot Dam
X4`6"
i
_ t
i.
33,
hPPROVED.
1¢ 6 ltM CORDANCE WIR,THE CITY OF
CLIM TINO AND OR -ES
t xv6"
DAT.
t SIGNED. of_Z
This set ,,ans ar • spedications MU;
• i be kept m the joL at a:l times and it is u
lawful t( make any changes or alteration r
on same without written pe.mission fro '.
the buil( ng Dept.. City of Cupertino.
125+ �7 r i ne- stamping of this plan and specification
SHALL NOT be he d to permit ar to be a 4
approval of the v:ofatian of aay prDlrl3ior
,f Inv ON n d nance or State Law
OFFICE COPY4t'6"
14.' 317"
SEP ¢
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61TY OF CUPERTINO o c.5 7 6,2
DEMO
CUPEKTINO PERMIT APPLICATION FORM
• APN# Date:
Building Ads : �`
?031v- G,01'4 G CAA h
OwIIII11er's 3atne: I- T '!I,, / Phone #:
Zvl[M �LA C"yt ,J I uN IZlivaK (4-0 9)
Contra or; C� License#:
Contact ✓✓; ,")" Phone #:
lj(/ ��+ C C 3 0 -s�
Applicant/Contractor.'
Building Permit Info:
Bldg Elect Plumb Mec
Job Description: ) /
Residential: '� rcial: ✓l/
Sq.Ft. Floor Area: r $/Sq.Ft.
Architect/Engineer: t, Valuation:
Type of Construction: Occupancy roup:
r
Qty
A is bl Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
• �3z73
r / 79 ,
CITY OF CUPERTINO x r' �e*�va �*"'�`s+r '�s' v.,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: _ ZHONGHUA CHEN & JIANPING Z �1' O03090214
R'S NAME: PERMIT ISSUE DATE
, ZHONGHUA CHEN & JIANPING ZH AN 09Z24/2003
PHONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT IN
BLDG ELECT PLUMB MECH
0 0 0 0
+o o LICENSED CONTRACTOR'S provisions DECLARATION
Eu F I ionI .)grin that 1 am licensed i nrtcr Pof Chapter 9(commencing Job Description
zw wile smction]aknnromisron3ortne nnsinas arta Pro&salons ewk.arta my license is �
,vo in full to=and effect. DEMO (E) POOL
p,a z License Class Lic.Is /
i F a Dow.Contractor
ARCHITECTS DECLARATION 1
I w U I understand my plans shall be used az public records
eO'I Licensed Professional R S
g
OWNER BUILDER DECLARATION
0 1 hereby.('firm un[bar I70 1. exempt from Inc Contractors res LiAny c Law for the
00 following reason(Sauer]ensu t.alicss and improve.
de Professions Crude:Any city or county
i m which its requires a permit re cn.wa.applicant
improve,h crmiit l or repair any ioncomat $3500
ryiortn its issua d ppm requires Nc anplicanl R c Cob pe tars License gned nmemem
;ZO (commthathiceScing wJ pursuao7")of vivions3 of the
insiness LiCenseLamx haptCT9CudC)or Sq. Ft. Floor Area Valuation
[� (cat he
ingwith Section
te. it the
Waris for the alegedCssand pt..0 A ,aCndgser 36936039 . 00
i Net he is excmpl asmf.m and the basis for the alleged exemption.Any violation of
notSecmn]WLSby hny undredapplicant
rs($51 Permit subJccu Ne applicanuoaCivil Penalty of APN Number Occupancy Type not more than f hundred dollar(SSo0). -.
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.IIkd,Business 704 DEMO
and Professions Codc:The Contractor,License Law aces nm apply to in owner of Required Inspections
property who builds or improves Neuron,and who tlas such work himselfor IArough his
own empki provided that such improwmencs are not intended oroRered ferrate.If.
however,Ne building or improwment is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for Purpose of
sale.).
❑ I,as owner of the property,am exclusively contracting with licensed contractors to _
conswet the project(Sec.7814,Business and prolamin.Code:)The Contractors Li-
cence Law docs not apply to an owner of properly who builds or imnmws(hereon,and
who contracts for such projects with a conmetor(s)licensed pursuant o the Conractofs
enm UIP,
1 am expt under ec. B&P C for this mason
Dam all
WORKER'S COMPENSATION DECLARATrt •�
1 hereby affirm under penally of pe jury one of the following declarations:
❑ I haw and will mainuin a Certificate of Consent to self-insumfor Worker'eCumpen-
sation,as provided for by Section 3700 of he Ubor Code,for the performance of the
work for which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for Ne performance of am work for which this permit is issued.
My Worker s Compensation Insurance carrier and Policy number art:
Carver: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
obis genion need amt he completed Strait permit is fm one hundred dollars(5100)
or Icss.)
1 certify that in the rarformenec of the work for which this permit is issued.I Shall net
employ any person in any manner So az to become subject to the Workers'Compe.ation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:V.after making this Certificate of Exemption,you should
become subject to the Worker's Com saturation previsions of the Labor Code,you must
,Z fonnwi to comply with such provisions or this permit shall be dimmed revoked.
zO CONSTRUCTION LENDING AGENCY
1 hereby Warm Nal there is a Componential lending agency for the performance of
x thc work for which this permit is issued(Sec.3W7,Civ.C.)
y Q Underi Name
Z) Leader's builder's Address
J Q 1 Certify Nn 1 haw read Nis application and sate that the above infmma.ion is
y ,: correct.I agree to comply with all city and county ordinances and sum laws relating I.
tJ building Construction.and formbyamborimrepresenmlivms of this oily to rooter upon Nc
W above-mejudgra property rnri.peeuan part,awhich Ma.
0. (We)agme to save,indemnify and keep Wingless the City or Capetian againstI,l '
Z in Consequence
of the gents and espnsmsmit. may in any way Scenic again.Baia City
;JZ in consequence of the graining.(this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WI ALL NON-POINT Issued by: Date
SO RCE REGULATI NS.
_2_ � 9/LY/•3 Re-roofs
,�!Wtrt ofnpphcantafontractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle havardous mamnil
defined by the Cupertino Municipal,Corte.Chapter 9.12,and the Health and Safety
m.C]Y�:zss3z(a)? n All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occn quip If a roof is installed without first obtaining an inspection, I agree to remove
rap 6 Pana y A equipment or devices which g
emit hazardous air conmminanr as dcGncd by the Bay Area Air Quality Management
District? all new materials for inspection.
'
❑Yes CK4u
1 have mad the hm4Nrms materials mgulmments under Chapter 6.95 of the C.1dre-
nia Health Z SafmtyCode,Stttin.255115.25533 it 25534.1 undersmnd that if the marding
dors not cu I ase a anent,than it is my respo.i bilis,m n ally dre o¢up.,or the
rtyuimmenu ren masa be mel prior to manometers eeruficam of Gccupormy
jiv� Signature of Applicant Date
owneruranthn
rind a cm Da1C All roof coverings to be Class "B" or better