05010139 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CQAI�TRAGrTOR TNF.0 ACTON .
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BUILDINGADDRESS: AIT YEH MING Z AND LILY X ET A PERMITN005010139
` OWNER'S NAME: PERMIT ISUEDATH
NE: SANITARY NO. CONTROL NO.
7ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECTPLUMBMECHaLICENSED CONTRACTOR'S DECLARATIONJobDescrition
I barely arran Net 1 am licensed under provWans of Chapwr 9(commencing Pmtwn]0111)ofDivWon 7 ofNe Bucinexs and ProfcuiomCade,and my license ie
l torte andeRect.
sa Clw Lw.S ADD 1113 ' (MS BED/FAMILY/KIT/DING)
CAn
ARCHITECTS DECLARATION
] I uncensored my plans"I bu used As public mcmda '
Cu. Licensed Professional
t'O OWNER-BUILDER DECLARATION
f 1 hereby Mran that 1 am exempt from the Conusaor's License Law for the
i O O following recon.(Section 703 1.5,Business and Professluru Cade:My city or county
un which requires a permit to construct,alter.Wprove,dcmulleh.or repair any structure
Fly pdwwimiss m,alsurcquiru NeappliesntfwwchpermitmOwaalgnedwmment ,
gigp < that he ts licensed puau.nt to tine provision of the Conuacor's4cense lase(Chapter Sq.Ft. Floor Area Valuation
5rt0 (commencing wit Section 7000)of Division 3 o the Business and Profaulam Code)Or
that he B exempt temfrom and to basis for Nn alleged exemption.Any violation of $150000
Section 7031.5 by any applicant for a permit subjects to applicant an a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑1,An owner of the property,or my employees with wain As Oak sok compensation,
will do the work and the struaure is net intended or offered fin Ilk(Sm.Road.Business Required Inspections
and Profaaiam Cade:The Comeacoel Limns Law does not apply w an Owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employes,provided that such improvements An,not Immntled or offered for We.If.
Wilder F the building or improvement is h td within oro year or mmove for the owner-
howk r will have tiro burden or
ro ement i that within
not build w Improve for purpose Of
ulcJ.
❑1,as awour of the prepery.am eulusively contracting with licensed contaaota to
construct La the project(See.An th,Business and property
who m CodeI Theves un e en.Li-
mac Taw dons not apply w an owner of property who builds or improves thereon,and
who contracts for such projects with a conuaewr(q licensed punum in Ne ConvactoM1 C�
License Law. /
❑Tun�exyem�pt underSe�e /�.�. � .Bk PC fin Nis moron
Owner //LI+a9//s1'W-T/ Data
-S�ORKER'SC PPNSATION DECUBATION
1 hereby dam under penalty of perjury ane of the following dmlarstimor
731.'Yl
Nin sed will maintain accNfvw of Coment m self-Wum for Worker's Canpen- /b
n,u provided far by Section 37M of Ne Mbar Cade,for Ne performance or du
k for which Nia pcnnil b iaswA.
have and will maintain Waster's Compensation Irsuaance,u required by Sedan
of Ne labor Code,far Ne performance or the work fin which Nie pe ashis Wised.
Worker's Compewtion Inwranee caller and Policy number are:
er. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS '
COMPENSATION INSURANCE
massocliam rad noteccamplced Ede permit is fmmehundmA dollars;(SIM)
or IGF)
I certify that in the performance of the work for which this permit is issued.I shell not
employ any license In any mannerso u in become subject in donV1aryeri Compewa.
Laws of Califamia Dn r ,Z,61j� ,
A licant I
OD nit
N come iTO APn t eA rf: f,a(�iini Nis ov fines Li bar on,you show
becomesubjecty it Worker's Compensationpmviswru cruse lab^r Code,. roue
.J O forthwith comply with such provisions or this permit shall be rimmed awaked.
z CONSMUC170N LENDING AGENCY I hereby aBimt that then is a construction lending agency far the performamcot
lY the work far which this permit Is Issued(Sec.3097,Civ.C.)
10 QIander'a Name
M
z Landers Addreas
U Q I certify that I have read this application and Nin Nn the above Information u
D. coned I Mom in comply with all city and county oNimnces and suns laws mladng an
Q building communion.and hereby authodre representatives of this city w enter time dm
W abuve-mentioned property for Inspection purpoeeF
Q. (We)agree he sive,indemnify and loop hardens the City Of Cupertino against
In Ilabilides,judgments,coats and expemes which may in any way wave against said City
U7 ucomequenmof Nan
egrting ofthis Pemdt.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
—SOURCEnEGULAATIONS.
3A*leRe-roofs!!a
Sm.urann /
Dew
HAZAR15OUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or futuae Wilding accuput more orlundle hassrdou material
as de0ned by the Cupertino Municipal Code.Chapmr 9.I2.and to Health and Safety
code,Section xsslx(a)T All roofs shall be inspected prior to an roofing material being Installed.
❑Yes ON. P P Y g g
Will the applicant or future building occupant use equipment w devices which If a roof is installed without first obtaining an inspection,I agree to remove
M
hnaNaus air contaminants as dcfmcd by Ne Bay Ama Air Quality Management all new materials for inspection.
Diwiml
❑Yes ON.
I have read the huaNms materials requirements under Chapter6,95 of he Califon
nix Health@Safety code.Scam 25505,15533 and 25534.1 urwerstaM IhmiftM building
dors not currently haw a wnanr,that It is my respontility w ratify the amupant of Ne
rcquircmc which t be metpdorw issuance ora Ccnifma ofocmpancy. Signature of Applicant Date
3 All roof coverings to be Class"B"or better
Owner lir wl zcd agent if Dam
If/