06110033 CITY OF CUPERTINO aq %
BUILDING DIVISION PERMIT C®NTR"ACT�O,R•III+ORMA T, ON '
T NT
BUILDINGADORETS: DWK CONSTRUCTION PERMIT NO.0611
1031
OWNER'S NAME: PERMIT L4UE DATE
PING PANG 18665 LORRE AVE 19/041/2006
NE: - SANITARY NO. CONTROL NO.
(408) 615-1508
ARCHITECRENGINEER: BUILDING PERMMNFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION lob Description
w F 1 hereby affirm that 1 am licensed under provisions of Chap,.9(commercial P
:<W with Section 70M)of Division 3cfJte BusinessuM Pmfeaciotu Cods.and my 0censeu
in fall farm md,ffen. HOUSE DEMO
License Class Lm.M
Dam.Contractor
ARCHITECTS DECLARATION
i I understand my plans shall Ise used as public recnrsh
iyU
"off Licensed Professional
<5 02L I am exempt ro DECLARATION
f I hereby resum a(lonSwe Not 11. exempt from Um Contrltucco Co License c law for the
p o which m muon.Permit
t 703 1.5,Business and Professing Cede:Any city of county
e m which rtquirn a permit w emnstmeL a1tu.improve,demolish,or repair any swetum $10000
ups^ total w is achnown.also Mquirrs the applicant for such permit ut file a signed suvmeat
'�< th.,boiaRan:cawraaant,otnepm.iaioasnflnacontmemrfuanrevw(ehapmr9 Sq.FL Floor Area Valuation
`�$ (commencing with section 0000)of Division 3 of the Business and Professions Code)or
u
— that he exempt therefrom and the basis for Bre alleged exemption.Any violation of
Section 7031.5 by any applicant fa a permit subjects the applicant to a civil fatally of 3AW lVrA&cFUQOccupancy Type
not more Nan five hundred dollars($ L
I,as own.of the propmry,ar my cmple,cn with wages as their vale eampewton,
will do the weak and the swetum u mtiemnded or offered for Saw(Sec.]04L Business Required Inspections
and Professions Cade:The Contributes Liberian law duties rein ns
ot apply an Owner of q P
Property who Wilds or improve thereon,and who duessuch work himself at through his
Own employees,provided Not such imprnvemmu are not intended moffered for sale,It.
howev.,the Wilding or improvement is sold within arc year of completion,On Owner-
Wilder will haw the WMm of proving than he did mt build or improve for pulp=of
sale.).
❑I,as owner of the property,am exclusvefy conuasum,with li.nacd mnuaclors lo
construct the project(Sec.70a4.Business and Rareasiam Code:)The Counselors V.
come Law does not apply in an owner of property who Wilds or improves Ihemon.and
who concocts for such projects with a contrabut licensed pursuant w One Contractor's
keens law.
❑larneaemptuawb See .B&PCIm Wisown
Owmr m
WORKER'S COMPO ATION DECLARATIO
1 hereby afrum under. .a perjury ore of the fallowing d.larsWm:
1 haw and will maintain a Cera fibuta of Comcnt w self-insure for Workers Campcn-
sa,ion,u provided for by Section 3700 of Ne Labor Calc.for the performance of the
work for which this permit is isma d.
❑T haw and will maintain Workers Compensation Insurance,as myuimd by Section
37W of On label Cade.far the performance of the work for which this permit is issued. '
My Workers Compensation Instrown rani.and Policy number are:
Carrier. Policy No.: _
CERTIFICATE OF FXWPTION FROM WORKERS'
COMPENSATION INSURANCE
Crisis section recd m,be completed if the Permit is foram,hundred dollars(SIM)
or less.)
I certify that in the performamc of the wall,for which this Permit is issued,l shall nm
employ any pefmn in any anatn rsy r(myecome subjecl a the Workeri Compensation .
Laws of California.Dyp /cY/O+fi
APPllcant //10/DGS .7
NOTICE TO APPLICANT:If.after making this Contribute of Exemption,you should
become subject in Uro Workers Comper aeon provisions of the labor Cade,you mus,
.J O fora ith comply with such provisions or this Permit shall W decmcd mwked.
Z ry CONSTRUCTION LENDING AGENCY
r Iherehyalfirm does there isocia.inn lendingagcmy for the PeRunnarce of
(Y> the work for whim this permft is issmd(See.3091,Civ.C.)
ap LendcesName
z lenders Address
U O 1=iry Nat I have mad this application and sero:thin an above information is
(� f^ correct.I agme to comply with all city and county ordimmba and sum laws relating to
�U building conswction,and hcmhyau,horiee rtprescnmtiws of this city to enter upon the
J+0. abovomcnuancd property for inspection partials,
(We)agree to save,indemnify and trop harmless the City of Cupcnino against
f^' Z incortie;juda,orOncostsand ex penseswitch may in any wayorotic againasaid City
U Z APPLICANTeUNDERSTANDS Agreathig Of rND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. /
f;'����ri �s 9=7g"*_O'!j Re-roofs
Signature of ApplicanUCanuestor Dam
HAZARDOUS MA ALT DISCLOSURE Type of Roof
Will Ore applicant ar future building amupant store or handle hanrdom material
as dcMcd by Bo Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
bade. Yzss3z(a>+
C ,,,,,,aaaNo All roofs shall be inspected prior to any roofing material being installed.
40 Ter KI
/\ If a roof is installed without first obtaining an inspection,I
Will the applicant or future building Occupant use equipment or tkvices which g agree to remove P
emit hazinwou air contaminants as tcfin,d by the Bay Area Air Quality Management all new materials for inspection.
District
Qyn 10NO
I have mail the haaardswamawrials mquiremen;under Chapter 6.95 aftheCalifof-
nublmda&SdmyCOdc,Scctiom25505.25533 and 25534.I understand thatifthe Wilding
Jas at,.city hove a tenant.Out;,u my rmpoosibilit,w netifr the occupant of the
oc'mmmenta which must hemetpdor aanm of.certheao or Occapaney' Signature of Applicant Date
.o —o�
Dw 10thad,�dagent Dam All roof coverings to be Class "B"or better