08050192 CITY OF CUPERTINO �"--rti'.+• tg;
BUILDING DIVISION PERMIT kCONTRACTOR¢INFvRMATION.
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Bu11.[jIg(Qj,3pQ1REsIMPERIAL AVE TBD - TO BE DETERMINED 08PERMIT050192
AUS NAME: PERMIT ISSUE DATE
ANGELA LIAO,CHI CHUN LIAO, 05/27/2008
PHONE'T n T 'r n n SANITARY NO. CONTROL NO.
ARCHnER/ENGINEER: BURRING PERMIT INFO
BLDG EIECr PLUMB MECH
0 0 0 0
tato Zp LICENSED CONTRACT'OR'S DECLARATION Job Description
0 1 Man"affirm Nat I am license under pmyisiana of came,9(c.ratem Ing p
n withSection7010)ofDiAdmi3aftbeBoia.andPofevdomcause,andmylicenseb RMDL BTH (55SQ) , LNDRY/UTLTY(85) &KTCH(170SQ) , RPLC
i�_ �icamseaclu.deffe[L Lac-9 EXTNG WNDWS &MODFY 2 EXSTNG WNDS & SOME INTER
o Dam ARCHITECTSD�ECLARATIOnWALLS; NO RE-RF& NO STRUCTURAL
U [understood my plans shall le used as public records
I'C t; Licensed Professional
OWNER-BUILDER DECLARATION
I Wrehy af0rm tint I am exempt from He Cantnmors License Law for the
i 0 o following revan.(Secom 101.5,Business and Pmfesiou Cale:Any city or county
$Pi which requires a permit m construct,alcor,improve,dcmnRsh.or repair any muetum
prior m its issuance.abse requires the applicant for such Namitto file a signed aummeni
ESG that be is licensed pursuant to He provision,of the,camtracmrl Liceue Law(chapter 9 Sq.Ft. Floor Area Valuation
xh (commencing with Section 3000)of Division 3o(de0minors,and Professions Code)a $15000
E 5$� Nat he Is exempt 0tere(rom and de hub for the alleged exemption My violation of
Section 3031.5 by any applicant far.permit Wbjecu the applicant to a civil penalty of ,yp N Number Occupancy
not more than five hundred dallus(S5WL 35719043 . r1C P Y Type
1,as owner of the Property,carry wPloy.with wages u deb sole mmpenvum.
will do the wa&and the awcturt is not intended or offered for Sale(See.3014,Budnw Required Inspections
and Professors Cade The Canuxmts L.ianu Law dors tot apply m e ns an owner of q p
Property who builds orimproves Hereon,andw W doessuchwak himselforlluough his
awn employers,provided Jut amb impmtemenu am Trot intended oroOerW for We.If,
however,the building or impmmnmt is sold within am year of comple tma,Ha owner-
builder will have the burden of praying that be did not build or improvm for pamess of
ale.).
1.u owner M the Property.am exelumniy contracting with licensed rontracmn m
homes He project(Sec. Butinm and Professions;Code:)The Comactor's U. .
c•••-Law doe at apply m an owner of Property who Wilds a improves from,and
wW commas fors prokcuwiHa r(s)licensed pursuant m the Convacuses
License taw.
ase sods / .B&P this reason
r Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty e(perjuay one of the following dmlaratiou:
Cj
1 n<r<end will mainuin a Cerofieteof Consent m self-assert forWartcraCampcn-
nmn,Is Provided fa by Section 3300 of Use labor Code,far the performance of the
work for which His permit is issued.
❑I have and will maintain Workers Campevation lasuance,as required by Section
37W of f Latar Cade,fa the periormame of He work for which His permit is issued.
My Workers Compsouuon Inwrance curio and Paley number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
must seen head not be cwPleed if tW permit is forces hundmddoBus(SIM)
or leu.)
1 certify that in tW performance of e t fa which His permitis.sued,}shall am
employ any person in mymannerWjs ubjrctn//�rken' tTiPevaoun
Laws of Califomia-Dam
Applicant
NOTICE TO APPTd�NP. rZna n m .you should
become a.him m f i ompenmuun provisions of Oc fabs Code you mus
.,0 forthwith comply with such Pmvbiou or Hb Permit shall W domed rewked.
'Z CONSTRUCTION LENDING AGENCY
f-' Iberehyaffw that Jan is aconsuuctina lending agency for He performance of t
6i> He wart for which this paamit is aimed(Scc.3093,Civ.C.)
WM Q Lender.Name
z Landers Addmu
U Q I cannily Hat 1 have red His application and sum and the aWw information is
U, ^. correct.11.In comply with ill city and county ardimanee and same laws relating a
0 SVS Wilding construction,and hereby autharim rtpmxnti of His city in enter upon the
W shove-mcnuormtl property for inspection which ms
gy (We)agree m ave,indemnify and kap harmless the City at Cupenom against
sn incoiUetamccoJudgme,nu andespcue which may in any way acuuc agaiutseidCity
t 1 2 in caecgancc o� tine a( renis -
'-" APPLICA RSTAN D WILL PLY WITH ALL NON-Po Nr Issued by: Date
S CS N�A�.v�(t
��Q Re-roofs
cure al Apphcen✓Conuacmr Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will He applicant or(mum Wilding aeupant von or handle havNaus material
fined by He CuPenino Municipal Code,Chapmr 9.13.and He Heald,and Safety
.Sccuon 23332(4)?
❑Ye �f�(g a All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupam use equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havaadnu air cenuminaru Is dcrined by f Bay Area Air Quality Mamgcmcat all new materials for inspection.
District? P
0Yes >9!Nu
I have read the Washroom,materials requirements under Chapter 6.95 ofd,Califor.
niaHulth&Safes A,Sepiau 25533arW .I urWcssmE HazifJe Wilding
dos net corm Y,haic a mom at ii b my rt ihililY m noufy dar ace"cot of de
79'ireme which W Ip6mm o-&ccrore.mora gnature of Applicant Date
c� 2
mer ar,at adsd ascot mm' P All roof coverings to be Class'W or better