04070036 CITY OF CUPERTINO �"°' *'* " ��"�' " ` *"
BUILDING DIVISION PERMIT £ CONTRACTORINk'ORMA.TION
BUILDINCADURPSS: GIANT CONSTRUCTION PERMITN0040 10036
OWNER'S NAME: PERMITLSUEDATE
CHEN-PEN
E:
SANITARY NO. CONTROL NO.
50 17-
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION Job Descri tion
UW I timothy affirm that I am Ixemed under provisions or Chapter 9(commencing P
i with tion 7")of Division 3 ofthc Busircas stafFinefessi meudc,arM a' xis
in foIlfp nderre� Q DEMO (E) HOUSE
zn tgi License Clnu--(� —Lie.
Date Contrsmr
ARCHITECT'S DECLARAT ON
?wU 1mdc my plan all be uuJupu
3 u.I- Licensed Professional r 0
"03OWNER.BUILDER DECLARATION S
iP 1 beony affirm that 1 am exempt from the Contractors License Law rot the
i p O following rtvmm.(Section 7(n 1.3,Business and Profesduns Cade:Any city at county v
w m which¢quires It Permit to Count...alterimprov,&--full.or repair any oucture
v�'^ prior its issuance.aim requires applicant for mch Permit file a signed ststemcnt
Nat he is licensed pursuant to dre pmvisioumf Ne CrOmmeturi Lice
nse,law(Chat9 Sq.F[. Floor
x es the Area Valuation
61- (Commencing with Section 7")of Division 3 of the Business and Professions Code)or
i $
But,he it exempt therefrom and the hues for the alleged exemption.Any violation of �.vsrnr�m�vra
Section 7031.5 by am applicant fora permit subjects the applicant a civil penalty of 3Cf�PIH'41tM6Coo 0 Occupancy Type
not mart in.five hundred dollar(3500), m
❑1,u owner of the popery,m my employcu with wages u then ole compcnsstion,
willdo the work.and the structure is notimended m offered forsa(c(Sec.704a,Business Required Inspections
and Professions Code:The Commcmrs License Law does am apply m an owner of q P
property who builds or i m proves theman,and who dos ouch wart himx If or tlumugh his
own employees,provided dim such improvements Are motintended oroffered forsale.If,
however,Ne building or fmpruwment is sold within one year of completion,Ne owner.
milder will have the burden of proving that he did not mild or improve for purpose of
k.l.
1,as owner of the property,am exclusively contracting with licensed comacrors to
o wct the project.(Sce.J014,Business and Profusions Code:)The Contracter's Li.
cc
nse law docs not apply m an owner of property who builds or improv Merton,and
who convents for sato projccu with v contrumr(s)licensed purouem to the Convemor'a
License Law.
❑l am exempt under See. B k P C for this moon
I Date
WORKER'S COMPENSATION DEC, RATION
1 hereby affirm under Nulty of perjury one of the following dreluations:
I haw and will maintain aCenifleme of Consent ro self-insure for Worker's Compcn.
tion,u provided for by Section 37W of the tabor Code,for the performance Of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Imoramo,u required by Section
3700 or Ne labor Code,for the performance o which this permit is issued.
y Workers Co n mac of .Mram:
mer.
CEfmFT EX Eh PIT OM WORKERS'
OMPENSATIO N RANCE
(Thu senior need not he completed if the permit Is forum hundred 011.($101)
or less)
I certify Out in pronounce,nouncµpn,,,c or the work for which this Permit u i d,I sh
employany the an Y yyy'Crmaa m heman.SUthKLG1011n
Iawsof CL
App rot
N ICE API! ,after making is Cent r Exemption,you Nuum
2VOI jmct to the Worker's Compensation provisions of the IaMr,Code.you mon
Z, foI Comply with such proviainv or Out simit shit be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
1-. I hereby alfren Out,ft.iso construction lending agerry,for lnc pcHormarax of
lYi> Um work for which Nis permit is issued(Sec.3197,Civ.C.)
U]0 Leh endName
IST Lender's Address
U O 1 canify,that I ban read Nis application and sate Land the show informNm is
ly (•" mrrtcL 1 agree to comply with all city and county mdrumecs and sax laws miming in
C.7 Wilding Construction,)agretoand wticrtemnifyby d n:pres^utiwa of this OfCUy to nterupon the
above-mentioned propery for inspection pugp L
G (we)agree to taw,indemnify and gap hay I.an the City of Cupcnino against
F'h
liabilities.judgments. andaapcnsa which may in any way accrue against said City
U Z in comequc f Nc goring of fl u Pcrm'L Date
'll&,D�a
APPLICA NDERSTANDS AN LL COMPLY WITH LL NO OINT Issued by:
SOUR EGULA770NS.
7Re-roofs
rgn or pplican orate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant time or handle havallo e,material
u defined by the Cupenino M���_en35'ms'pal Cade,Chapter 9.11,and the Hcalth and Safety
1
Code.Smtim15531(a)T x All roofs shall be inspected prior to any roofing material being installed.
o Yas
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha,dnus air contaminants ns JCMCJ by the Bay Area Air Quality Management all new materials for inspection.
DixuicO
❑Yes Nu
I have mad the harardous materials requirements under Chapter 6.95 of the Cah(m.
ria Hcallhg:S tyCodc,Smdou15505,35533and35534.1u.kc andthaifthchuildimg
docs rat cu by haw I tenant Nati y rcsponsihilitY m motif' the scup t of the
or, t rthmustM1cmet rssmaneeOfeLbnificam Occupat . Signature of Applicant Date
eDate All roof coverings to be Class"B"or better
1 0 a sen