07090040 CTTY OF CUPERTINO �»;P�rowT„.9¢?� o� a� t" � -
BUILDING DIVISION PER MT ,,CONTRACTQRKINFURMATIO
PERMIT NO.
Bu1LTf Af3O@,ESS.-C CLELLAN RD YONGJIAN WANG 07090040
ERR'SNyAEM�E:: M PERMIT ISSUE DATE
YONGJIAN WANG 21988 MCCLELLAN RD 03/27/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECMMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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sea,
LICENSED CONTRACTOR'S DECLARATION -
a 1 bereby.form wt 1 w licensed nmcr pnviainns erQapser 9(enmme,eing Job Description
" with SecWn700(l)ofDoidon 3 ofde Bodnar and ProfcssiunsCWO,and my license is HOUSE DEMO
tr i i%iccnwCleasnd`H`a Lle.0 3/12/08 PERMIT APPL EXTENDED TILL 9/10/08
o Dam Contractor
ray ARCHRECrS DECLARATION
WDs,u 1 understand my pWu call be and as public record
l'o Located Professional
5 OWNER-BUILDER DECLARATION
I hatch,aRw that I am onempt fnm We Canucors License Law far tW
i o O following mason.(Section 7031.5,Bla eta and Padca ons Cale:Any city or county
$ which reclaims•permit to construct.all improve,dmulim.Or repair any structure
_Z> Prior to its issuance.atm requires the applicant far such permit to file a signed atsmmem
ss< mal he is licensed pursuant to We provisions or the Common's Ucmuc,Law(Chapter 9 Sq.Ft.Floor Area $ Valuation
yF lesson ungwith Srsdon7000)of Division3of We ness
Butimd Pmf=iom Code)tar 8000
y 5 F that be u eacept tharefrom and the basis far the alleged!assumption MY violation of
Sectton 70313 by arty applicant fa a permit subjects de applicant to a civil penalty of Number Ocean
ml mart than fico hundred dllan(SSW). 35608027!E� Occupancy Type
❑1.as owner of the Property,a my employees with wagon as Weir sale cempmenda,
will d We work,and the mature is net Woods d or oacmd tarsale(Sec.7014,Busiass
and Rofc tions Code:The Conummes License Law dean ant apply to an owns of Required Inspections
property who Wildaimprovea du+can,and whodocasuchwak himaelforduough his
owe employees,provided than such impmsemenu an,not intended attracted for sale.B.
hWev .We dtilding or ialpmYasnam is said within aK year of ewplednn.the eater- .
WiMen will bow the Wrdan of proving Wt W did res Wild or improve fa Purpose or
sate.}
M 1,as Owner of We property,w emlusively convecting with Resound anvanoen to
construct the project(Sec.7014.Business and professions Cod:)The Contranmes U. .
cave law dos not apply to an comer of property who Wilds or improws(hewn.cod,
who contracts for such Instant with a conuacta(s)licensed pursuant or the ContmctOrs
License law. _
❑I Or tad $see Data myf mason
Data
S
RKER'S C ENSATION DECLARATION
I hereby w under p At,.(,do,one of the following do madam:
1 haw and sill maintain a Certificate or Consent to elf-ivum fa Worker'sCompen-
,amn,as pmvid l fa by Socam 3700 of site labor Code,fa the Md...or the
walr far which W.pewit is Issued
❑1 bow and will maintain Worriers compensation Wenn¢.as assumed by Scion
37oo orthe fabs cod.fa the'do..Of lot work fa which this pewit is housed.
My Workers Compensation Insurance carrier and Policy number w:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This ectim seed anthecompkmd if the permit is foranc hundred dollars(Sim)
asless.)
I znify,loot in the pafomance of the work fa which this pewit is issued.I mail nen
employ any Nolen in any no Wmicen'Cppnnpe don
Laws of California Dam—L.L�.L_�/ / �y/tom/f`
Applicmt
NOTICE TO APPLICANT.If,a0er g dais Cc . u of Ewmp on, should
ould
become subject to the Waiter's Co tion Inv'' f the Labor Codc,you an= --
.,O fashwith comply with such Formica a this sha
is peit ll c dcemnd revoked.
z y
CONSTRUCTION LENDING AGENCY
[-+ l hereby aRiw that Nem u a construction lending agency for We perfowasse of
C the weak fa which this pewit is issued(Set 3097,Civ.C)
0 Iandrs Name
.7. z Lenders Address
U Q 1 amity that I low mad this application and sum dem the aWw iNoraid.is
U, E certak I stem m comply with all city and camry,on farces and ass laws relating to
0 Wilding cavuunian.and bembY andwrise mprexastiq of this city to enter upon the
show-me judgments,
property fa inspection puryozs.
W (We)agree to saw,indemnify and keep harmless Use City of Cupertino against
(VIz inconsequence eninetrucam and ea penscsmit. coq in any wyamut Mahound City
U Z inconsequence of We UNDERSTANDS
of this pewit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �C�y-dam
SOURCE REGULA S.
SA
Signausof Applican a Dam O Re-roofs
out DISCLOSURE Type of Roof
Will to applicant Or future Wilding oaupant vac orhandm incurious maarud '
as defined by We Cupertino Municipal Cad.Chapter 9.12 and the Health and Safety
.Section zss32(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑res /I�NO .
Will the, Kant or comm holding Occupant m If a roof is installed without first obtainingan inspection,I agree to remove
PP g p equipment or Manna which P
cD�hvurd,a air cenumivns u d0rcd by Use Hay Nes Air Quality Management all new materials for inspection.
❑Ya o
I haw mal We hvaamrials mquimmens under Chaper G93 of We Glifa-
nisHealth&Safety COdt Secu=IM5,25533and25534.1andrsmnd Waiftho Wilding
dem Out currently haw•mnane dust it is my responsibility to notify the occupant Of We
mquinmcnu whin issuance CcNOcam of Ocap / b Signature of Applicant Date
Owner a horczdage Dam All roof coverings to be Class'%¢"Or better