05120009 CITY OF CUPERTINO 7_ FZ
BUILDING DIVISION PERMIT `iCONT"C4TOR�INF�ORMATION
BUILDING ADDRESS: WELKIN INTERNATIONAL IND ff,�'IT"°05120009
104
OWNER'S NAME: PERMIT ISSUE DATE
JAPA JING LIAO 19925 STEVENS CREEK BLI 2,/n9.,/2ooc;
NE: SANITARY NO. CONTROL NO.
(408) 252-3396
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONIHACTOR'S DECLARATION
e C 1 hemby affirm Nat 1 am licensed under provisions or Chapter 9(commencing Job Description
b with Section 7")ofDivision 3 of Me Bmincv and PrafessiunsC de.and my license is
„ infull rnmeandcrreca �Z �� TEMP POWER POLE
Iqz
Dow
aaa Co a- [�
F o Dam - C ComrxCl_
-s 1 un ersunJ mY plans id l lic usW as public rte Ods
e0� LicensedPmssio
fcnal 9+ Z
a t OWNER-BUILDER DECLARATION
I Ircmby affirm Mat I am exempt form Me Conmacters License law for Me
p o following mason.(Section 7101.5,Business and Professions Calc:Any city or county la
m which mquirea a permit to consumer,alter.improve,demolish,or repair my structure a�[ger - 8500
Prior to its issuance,also require,the applicant for such permit so rile a signed sammcm
that In,islicensed punuirmtoMeprovulomofthe Contractor's Uceme,Law(Chaptm9 Sq.Ft. Floor Area // aluation
(commencing with Sauer20DymDivision Sof the Businemand Professions Cala)ur Y
i $ that he is exempt Nsmfrom and this bum for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
nor mare Man Eve hundred dollen($500).
T,uowner of the propvtY.amY employees with waguu thcv sole compensation,
wulmthework,aniftsumemreismaintenaedaolleedroraam(Sce.ywn,Bmtcia RequiredIns Inspections
and Pmlessim"Co":The Conuacmes License Law does Out apply m N OWner of P
property who builds or The Merron,and who does such work himself or through his
awn emplaycu,provided that such improvements arc not intended or offered(resale If,
however,Me Wilding or improvement is sold within mut yev Of completion.the owner.
builder will have the burden of porving Mat he did net Wild or improve for purpose of
sale.).
❑1.as owner of Me porpcny,am exclusively contracting wida licensed conuacmrs to
construct the Project(Sec.7044,Business and Profusions Cale:)The CommmM'3 U.
cense law does not apply an an owned of property who Wilds or improved Merton,and.
who contracts for such pmjeN with a m ntraemr(s)licensed pursuant to the Contractors
License Law.
FI 1 am exempt under See .B&P C for Mis mason
Owner Date
WORKERS COMPENSATION DECLARATION
1 bemby•lucre under perully of Perjury one of Me following declarations
1 haw and will maintain a Certificate of COmanno totelf-imumfor Workers COmpan-
suion,as provided for by Section 3700 of Me labor Code,for Me pnrformantt of Me
work for which this permit is issued.
❑1 have and will maintain Workers Compewuon Insuranm.as required by Section
37M of the labor Code,for Me performance of Me vol for which this permit is Word
My Workers Compensation Inwnnce tamer and Policy numberate
Grtier.!i;�tLIE �n.MC Polity Na.:,�.(1+M O�-
CERTIFICATEOFFl£MON FROM WORKERS'
COMPENSATION INSURANCE
(Thisseclirn need not W completed if the pmmit is fame handled Milan(SIM)
ur less.)
I Ounty Met in the Performance of the work for which this permit is issued I snail not
employ any pawn in any mannrm as ka become subject to Nc Woken'Compensation
Laws of Caiifomia.Date
Applicant
NOTICE TO APPLICANT:If,after making this CeniriOate of Exemption,you shouW
become subject M Me Workers Compensation provisions of Me Labor Cordo you must
.J Z forthwith comply w'ids such provisions or this permit shall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
[-i 1 bemhy arGrm Nat them is a eonswctimi lending agency far Me Mrformaac of
FL Me work for which this permit is issued(Sec.3097.Civ.C.) '
a Q Lender's Name
en ,
z
Lenders Addles
U Q I cenlfy Mat 1 have rad this application and trate Mm the above ofornation Is
LL P correct.l agree m comply with all city and county on inancm and sate laws mixing W
OU building construction,and hereby auloorim mpicwnutives of this city to mucrumm the
above-mentioned property for impection paryoses
F1 (We)agree to save,indemnify and kap ha mica the City or Cupertino a6vnsl
rq Iiabilitim,jWgmcnu.cosu and cxpcnsm which may In any way acmue againstsaid City �T
U zs permit.
APPLIICCUNDERSTANDS of the graming of t
AND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION 4�_2 /�/L// Re-roofs
Signature OfApphicanUCoSnDate
Da ere (
HA2ARDOUS MATERIALS DISCLOSURE Type of Roof
Will Mc applicant or future building Occupant store or handle baallous material
as defined by the Cupertino Municipal COM.Chapter,9.12.and the Health and Safety
aM.Sinsson[-]Y. (�(Ne
2ss32(a)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will Me applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil havardnus air contaminants as defined by dice Bay Area Air Quality Management all new materials for inspection.
Drainer?
❑Yea f No
Ihavemad McWar (a m=fialsmquimmenuunder Chapmr6.95of Me GlifoP
nia Health&Safety Ca ,Sceuom25MS.25533wd25534.lundersund Omif Me Wilding
docs net currently ham a tenant that it u my responsihility to nutil'y Me Occupant of Me
mgairtmena Which mmst be rete pierceusmaree er,cen;r pu_oraemparmy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorisd agent Da¢
Community Development
10300 Torre Avenue
< C � Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4$UPER,TINO
Building Department
JOB ADDRESS: PERMIT # O O O
c; O
OWNER'S NAME: - — PHONE # g a "
GENERAL CONTRACTOR: / FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile i
l Y d
Oder/ of a for i D to
CITY OF CUPERTINO
TEMP POWER
lCUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
Owner's Name: Phone #:
i Y� ` Li c&l7
Contractor: �J�Ik;N IN Phone: License #:
Contact: Phone: Cupertino Business License #:
Building Permit Info:
�✓�J''�'�¢i1 `j'" ,Qou.,<K- polo >
Elect ❑
Job Description:
Residential Commercial ❑
Cost of Project: wO w
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
�? 47,