00090092 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO
OWN
NANTtOE` g JOHN WY — — APPLICA'nuN,I t sive . .—
ONE LAI CHING—MIN AND SHU—YI SANITARI'N(.
C aeZ ARCHITECT/ENGINIiHR: —4 1 If I IUILDING PHRMI'IINFO
BLDC H1.14C'1' PLUMB M1IECII
rear
Ser L=1 1-1 I_I IJ
N= LICENSED CONTRACTOR'S DECLARATION Job Description
Z, I hereby affirm that l am licensed under provisions of Chaplet 9(commencing
F'^Car %sill Sectlon70(Xf of Division 3 of the llminess and Professions Calla and in,license
; i,in full force and effect.
z aI.ncs sec Cle Lir.If
x°a� Dat= CmnmebnWRTER HEATER
w 3 a H< ARCHn'PC'I'S DECLARATION ,
F'u'o J 1 undecmaml try dam.shall Mh osed:u pnbllc records'
swr :
a'c0, Littmsed Professional
WNER-BUILDER DECLARATION
v1 0,(II hereby affirm that I am exempt from the Cmuaua's Lima,c Law for the
1-Z's following town.ISalinl]0315,Business and Profossinns Code:Any city or crony
e whth ol,mad,.pder, t Iahe 1rem,dialuslikh.,ar ,,.a,any.trrun,
vde pr nna.it I. qu he p,li II hpc Ir 11 'b J.ttman
hale mph rsht n 11orae l he c tar %UrtToe Law(Chapter 9 Sq, Ft. Floor Area Valuation
leolmu,mul,with Sell ]01)0)of Divinin i 3,,f the Brines a.d Profesumns Crdcl
at that he is mampt metrfrmn and the basis for the alleged mangnion.Any violation
of section 1011.5 by any applicant for a'most subjects the applicant to a civil penalty
of not more than rive handled dollar,S500). A PN Number Occupant
❑1,as owner of the pmpenx or my employees with wages as their%site eomp=nmdon.
will Jo the work,and the structure is nal intended or offered far ball(Sec.TW. e
ummeti,and I'n,fcmium Cod the Comraaor%ucenm Law roma nal apply In ail 3••i9 1'9�0 -R fired Inspections
r ef'u".ty who builds apo
t lmmvthereon,and who doe,such work hi m¢If
sir Through hs awn cnq,luycca p ovid,d Thal sadh nmpavcmcnls am ion intended of
onored he all.If however,the nuddi..g m hnproyen=m is sold within ,as rear of 502 — FINAL PLUMBING ENERGY
icompletion.n.the owner-builder will have the bumlcn of proving that he did not build sir
mprov= purpose506 — GAS TEST
OLaaoxnet ofthe psiKsty.amexclusive;y m
comctmgwithrrensedcontractor,to 507 — FINAL PLUMBING
conntuct the project(Sec.704 1.Raciness and Professions Cadcl)'nm Contractor's
I.ittme Luse duo not apply In an oxrmr of ump,a,who builds sir Inqunvc Ihcrwn.
rad who cortara,ts for such Pmjce,with a vonvacmr(s) Ilconwd puruont ,,the
Contractor Lnacnrc Low.
❑I ion exenpl under Sec. .R k 1'C for this feta-
O sem, Date
WORKER'S COMPENSATION DECLARATION 2�
1 hereby affirm under penally of perjury one of the following declaration,: /✓
7 I boo l I will . a Cann Qcmc nl'Co.uant n,%ell-insure for Walker',
..inmin
Cerformemnon, to.he ark for rnv by Sec 1]1111 of the Luhnr Codu, far the
pxformancc of the work rnr which TAI„erv�iii is I%surd.
❑1 have and will maimain worker's Conlpen.mion Insurance,a,require)by Section
PW of the Labor Code.for the performance of the work for which this permit is
issued,My Worker'%Cmnpemalion Insurance carrier and Policy number arc:
Carrier: Policy No.:
C I'll I IICSFION OP FXEM1I VI ION PROM WOR KIiIts'
COMPENSATION INSURANCE
(This section need not be compared it the permit is for one hundred dollars
is Him.1 It
1 linty Ill.,in he performance of one work for which this permit i,issued,I
shall not employ any Person in any manner so as In become subject to the Workers'
Campen,alion Luxe of Califemia.Date
Applicmu
NOTICE TO AVPLICAN'1':It,fifer muklng his cel iBcate of hmn.ption,you"noud
rte oma.bell m Tho Wake, onga 'rn
,Cnsminnvknobs of the Lnnnr Cade,Y,...nota
Q O forthwith comply with such provlsiom or this Immdt shall he Jcmned revoked.
z
F'
CONSTRUCTION
TNG AGENCY
a I hereby ollich that There is s constructionl( . leading agency for the performance
of the work rm which Inas prrmn is issue)(sec.3097,civ.C.)
Y Q ado's Kann
T ],,I,cnJcr's Address
I cefil'y that I have read Im,appllanln...i and shine that me above ukarental
W Ems.,
correct.I agree to conhpay whh all lily..ad county rahmances and state laws relating
Q U to building construction.and hereby authmnm representatives of this city m enter upon
Ix: the above mentioned property for nmpection purposes. -
F,�, 13. (We)agree to save.indenni fy and keep hattmless the City of Coleman against
y liabilities,judgments,costs and expenw,which may in any way accrve against said
[,) Z City in consequence of the running of Inns permit.
SOURCE ANTU DERSTSNDSAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
REGSignature of ApprearoCnmmelm Date Re-roofis -
HAZARDOUS MATERIALS DISCLOSURE
wintheaMlicerntorfuturebuildingoccupantstoreorhandlehvaMou%material Type of Roof
as defienl by the Cupertino Municipal Ode.Chapter 9.12.and flue Health and Safety
Cute.Section 25512'n
oY=> ow' All roofs shall be inspected prior to any roofing material being installed.
Will rhe aplhrnmhl err future nr,ihrng na=npam me=grlpmrm and=,'fires which If a roof is installed without first obtaining an inspection, I agree U1 remove
hit harmluu,al.cn at thianu as drrincd by the Bay Area Ali Quel,M magmn=m
"Irirlo: orv.h all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
1 have read the hatardous ma¢nal,od,irentrnls under Chapter bills of the
California Health R Safety Coda Scaiom 255(15,25531 and 25534.l rndcrsland that
if rhe building does not comply have a manal,that it is my responsibility m notify the
overlent of the requirenenw which must he met prior to i%seance of a Certificalr of
Occupancy Signature of Applicant Date
I-aermnamonzed rgrn� nrlr All roof coverings to be Class"B” or better