05100050 CITY OF CUPERTINO ' x ., .-k,r ,«
BUILDING DIVISION PERMITCLINTRAC?n:RII�TFO.RMATIQ,N y
BUILDING ADDRESS: WELKIN INTERNATIONAL IND fftm""No'05100050
10495 GLENCOE DR
f"' ER'S NAME: PERMIT ISSUE DATE
JING LIAO 19925 STEVENS 2n05
NE:
SANITARY NO. CONTROL NO.
(408) 252-3396
ARCHITECtfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
too LICENSED CONTRACTOR'S DECLARATION
i Job DOSCrIpt100
G 1 therebyNrm Nat I am licensed umkr unw suns of Chip.,9(oro wwmg
s�swith Section 70(4h of Division 3 of NC Business and Profesdmu Code.and my license is
-�� in full romeandeffety DEMO (E) HOUSE
eve? Liernm Class Lk.♦ Ph le F Dam Colter
ARCHRECTS DECLARATION
I s< 1 underswnd my plans shall W used u public mcnNs
SyO
I
u t Licensed Professional D
`D 3 OWNER-BUILDER mDECLARATION F/1
tj f 1 hereby affirm Nal 1 am exempt from the C-do. o License AnyC Law for 1W (..
❑O following mason.(Section 7W 1.5,Business and Profesduu Cade:Any city Or county p
<m f which requires a permit on eonavuet,alcor,impuw.demolish,m mpair any structure �p,Q nn 2 5 0 0
°torprior.its iuuenec.alw requires themplicant forawhpermit to flea signed summem y
that he is licensed pursuant to de provisions of the Contractor's Uacue law lChapur9 Sq.F[. Floor Area J Valuation
euro (commencing with Section 7")of Division 3 of the Business and Professions Cods)or
i'
Out he or eaempt thmefrom and Ne basis for de alleged exemption.Any violation of ra^ �-•
Section 701 LS by airy applicant far a permit subjcco the applkanno a civil penalty of r 4v va.CU ancy Type
m
nmart Nan fico hundred dollars(5500). g` £
❑1,as owner of Ne property,or my employees with wage as Neil sole comlosadon, �`J
will do Ne work and Ne au muuaom u not imended or offered forest.(SOe.R .Business Required Inspections
and PtofessiCode:The Canctee,License Law,does rot apply in ars..aof q p
property who Wittiaw improv damouand wh.doescos it himselforthrough his
own employees,provided that such improvement,are not intended woffered for sale If,
however,Inc W ilii ng or unprowment is sold within one year of completion,the owner- �rs�
builder will baw de Wrden of proving Nat he did Mt Wild or improve for pmpme Of
V,,u owner of Ne property,am eaciusivcly contracting with licensed contractors;to
c rime.Ne protect(Sec.706x,Business and Professions Code:)The Contractor's U
cense Law dose nos apply l'an Owner of property who Wilds or improv thereon,and
who Con VdN for such P It colt Genn Vaetr(s)IICCIVCd puraUanttte Con4aclar's �/a
Lid.
Iam
exempt under Sec .B d P C for this
ver � Dau
^ 2 7-
R ER'S COMPENSATION DECLARATION
I hcrtb aRtrm under penalty of perjury ow of
In,
declamations:
I
willmainWaaCcr rill uof Comm�ttself-iuumfmWofte$Compcn-
sstian,as vided fm by Section J]o0 Of Ne faWr Cade,for Ne pcAOnnamm of Ne non
W
far ich Nis permit is issued. Ap
1 have and will maintain Workers Compcuuion Insurance,as required by Section
1700 of NC Labor Code,for Ne performance of the work forwhich Nis pmmit is issued.
My Workers Compensation Insurance canter and policy number art:
Cartier, Pali"No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITuscedion reed not W complcmd if the permit is froom,hundred dollars(5100)
Or kis)
I certify Net in the performance of ted wort far which Nis permit is Wised.1 shall not
employ any person Or an,mannc`,(pas t becomeserY.LLo Fde Workerifompcnsadon
Laws of California.Dam /•"L2-l.cv l
Applicant
NOTICE TD APPUCM :I,aMr making Nu Certificate Of Exemption,YOU should
became white t te)'orkch Compmt a ion provisions of the Labor Code,you most
.J O fortwidt comply wsuch provisions or Nis permit shall W domed mwked.
'Z"' CONSTRUCTION LENDING AGENCY
a Nwh fnch uthPermit is
adnsWttinn len ding agenry far Inc performance u(
(Sec.3097,CO,.C.)
a Q Landers Nam ,
=z Lenders Ad
U C 1 ttnify Nat 1 have read this application and sues Nat to aWw information is
LL F correct.l agree to comply with all city and county on imnces and sou laws relating t
DU building construction,and hereby authorize mpreacnutiv Of this city to enter upon Ne
r LLI shove-mentioned property forinspcction pMFosas.
(We)agree t save,indemnify and keep harmless Ne City of Cupertino against
liabilities,judgmeno,case and expenses which may in any way came against mid City
UZ in consequemw of Ne granting of this permit.
APPLICANT UNDERSTAND D WILL COMPLY WITH ALL NON-POINT Issued by: Date 6i
SOURCE REGULATIONS.
Re-roofs
Signsturo Of Appli amracmr Dau
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the
pliant orform Wilding Occupantamro or handle husvioas Material
u dc0ned by Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
I.Miremcma
Section 572(.1? / All roofs shall be inspected prior to any roofing material being installed.
u WNo
c applicantOrr ffuttuure building Occupant useequipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hauarunu air e,mumi...Is as deOned by Inc Bay Arse Air Quality Management all new materials for inspection.
istrict?
❑Yes C
IhceHcal"SafetyCode.Sccdmu25505,25533and25534.1undcnundNmifde Wilding
oes not emro dy hast a tenon¢Wt it u my rupouibility t tetify Ne occupant of Ne
which mut W met prior ante or.certificate of orcupaney. Signature of Applicant Date
Owner or auNarisd agent Dam i All roof coverings to be Class"B"or better
' '