05050063 CI TY OF CUPERTINO
BUILDING DIVISION PERMIT ONTRACT�QRR�NF QR r TION
BUILDING ADDRESS: COLOA CONSTRUCTION, INC PERMITNO.05050063
OWNER'S NAME: PERMIT ISSUE DATE
JENGHUNG CHE 7
iE: SANITARY N0, CONTROL NO,
408) 891-2449
ARCHITEGTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PWMB MECH
u00 LICENSED CONTRACTORS DECLARATION JbDescri hon
rd 1 hereby affmn that I am wo
lice
d under previsions of Chapter 9(commencing p
m with Scctian]gkl)afD'`vialon3of NC Businras and Pro(cssians o .and myliccnec is
n hlmuetoean efrectlL. 2�S'-� � ADD 11261 (2 BEDRM/LIVING RM/BATH)
i1�aJZ L
D+m kense Lk.N REMODEL KITCHEN
JJ`� cnnvuwr
o��i ARCHITECTS DEC R
Tun rwnd my phos sbillbousedupuhlic raorN ���� {�®
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OWNER-BUILDER DECe Conti ON
T mono affirm on I em exempt from the ConoamM1 License law co the
i C 0 which
following tonus a Permit
to co l.S.Business and improve.
do ore Code:Any city or county APR
I!1 2006
5$� whichtogmtosaPcmit mcrosthe +@a Improve,dcermittllc adganyatmttum PrR �G: L l7
�Sn intern)aIseItalssumc^rsuntto s^evisionof Forsucthe Cohmon's Lccnw LncdNpter9 q LOX34345
z< thatbohlkunsed pursuant to fDialomafNeComsiness ndProfeaw(Cha(Chapter .S PI Or ea Va
p$
(commencingelsxewit t SectionTODD)and Divhionaaf the
eged Business and Profession,My
Code)or
3 Natio h 31.5 b Westboro and Ne pun for be alleged exemption.Any l penalty
of
not
than
l ve any oil fora permit subjects the applicant m a civil pemlty a( AP Occupancy Type
not mom than Ow buMtoa dollars($5001 36936032 . 00 p y Yp
❑I,u ownerofdie property,mmyemploycea with wgesu dehsolecompewdm,
and dadewoes Chane, he Con Bml N6aded ofaw does
apply
aa.owner of Required Inspections
and arty who
Code:The ConoxuYa License law dao not apply lf rq ough of q p
property who s.proviimproves Neuron,andwho aressohann ethimself arthmagh his
own mer,due uiprogor i that such Improvements am ne year oed mplemed dorsale.ie own r..
however,due or improprovinlasold e did Out build
of completion,die owner. ,
builder volts haw the burden of proving Net he did ret Wilco or improve for purpose of
"In.1.
Q 1,as owner of the property,am exclusively contracting with licensed cemacmrs to
construct the project(Sec.7014,Business and Professions Cade:)The Contrator's Li.
team law does not apply m an owner of progeny who Wit"or improves Merton,and
who cen0crs for sob projects with a conuanort8 licensed pursuant m the Contractor's _
License law.
O l am exempt under see. .B h PC for this ream
........ Owner MT Dau
WORKERS COMPENSATION DECLARATION •..—W'
1 hereby affirm under penalty of perjury as of the fallowing declantiom:
I haw and will maintain a Certificate ofComenuo self-lesum for WodoursCompan-
ntim,u provides for by Section 37M of the Labor Code.(m the performance of the _._...
work for which this permit is Wood.
❑I have and will maintain Worker's Compensation Insurance.u required by Section
37W of the Labor Code.for the performance of the work far which this permit h issued.
My WerkeN Cam woo Inarana conn and Policy no/q�r r p
Carrier. t`h Polity No.: us i -
C RTIFl TE OMEMPIIONFROM WORKERS'
COMPENSATION INSURANCE
(This acture rad nothecanpleud lfthe ponet Is fmoahuubed dollars($]W) a
or leu.)
I comfy that in the performuce of thou work for which this Permit is Issued.I Mill not
employ any person in any manner se as;in become subject to the Workers'Cempemetian
Law of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Oullfiate of Exemption,you should
became subject to the Workers Compensation provisions of the labor Code.you most
rJ 0 forthwith comply with men provisions or this Permit be domed revoked.
'Z' r~N., CONSTRUCTION LENDING AGENCY
fr I
he alrom that them its construction lending agency for the performena of
Ce the work for which this permit Is issued(Sec.3097,Civ.C.)
WW 0 Lenders Name
D Z Lender's Address
t.p Q 1 coolly dust I have read this application and sues that the above Information is
IT,
comet.l Agra ro comply with all city and county ominances and sum law totaling m
Wilding convection.and hereby authoam representatives of this city to enter upon the
W above-meMonM property for impenkn Purpoan
py (We)agme to ave,indemnity and kap bsmless the City of Copenino against
o-y y
nconsequen
li+bilhksjudgmenu,cesu anu dexpenswhich may in my my accrue against said City
L)7 Ice the gmming of this permit.
of
G7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO POINT Issued by: Date
SOU77EGULATIONS.
Re-roofs
Signature afApplianVConmcmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Novo Wilding asupant nam or handle husNous material
as de0ad by then Cupertino Municipal Code.Chapter 9,11.and the Health and Safety
thee.sectiea zss)z(a)?
Yu p No All roofs shall be inspected prior to any roofing material being installed.
fop
❑
Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
it h+ramous air conuminenta as donned by the Bay Arta Air Quality Management all new materials for inspection.
s rici7
❑Yes Nu
I have mad the haardous muudidsmquimmenu under CTsptM6.95 o(the Califor.
niaHmlWB SafnyCodc,Scam 15505,I5555aM15534.T undmuM thuifthe Wilding ret, V
dos net currently haw a tenant.thus it h my mspomibility m notify de oaupant of tie
myplr�m�icn/�n�W��etpa� "'0"cgniTp�prgmopan� Signal eofApplicant Date
Owner or authorized agent JS� / Date All roof coverings to be Class"B"or better