05050080 CITY OF'CUPERTINO
BUILDING DIVISION PERMIT ,1CUN '.RACQx2T 'k`U, ATIQN
I BUILDING ADDRESS: PERMITNO.05050080
10566 MERRIMAN RD
NRas NAME: PERMIT ISSUE DATE
BINGQING HIJAN 04/06/2006
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEE0.: BUILDING PERMIT INFO
BLDG EIECT PLUMB MECH
I� o
i00 LICENSED CONTRACTOR'S DECLARATION Job Description
Ia I hertby a1Rtm dust 1 am Imcaed under pma vleioof Cha sat'9(commencing P
`pMSation70M)afDividan 3 of the Budnea and Profaadom Conn.and or license is
mIna force andeffea ADD 783 ' BEDRM/BATHRM/LIVING RM
,qz Li".ac°°" Lm." REMODEL KITCHEN
Dau Contractor
ARCHITECTS DECLARATION 12/21/05 PERMIT APPL EXTENDED TILL 5/13/06
fI understand my plans shall bo Used as public meant,
5�U
�a Licensed Pmfoaioai
3 OWNER-BUILDER DECLARATION
iI hereby aRmm that 1 am exempt form the Contractor's License Law for Ote
CO fallowing mason.(Section 703 1.5,Business and Professions Code:Any city or County
5If which mquires a Permit to Construct slur hnporve,demnllM,or repair any strucum
_Zw, miorbiu it,licensed
e dpursumquime thovisio sof far Cohpermitmftte at Law(Cesium
< thatheusismwUpumesemmtasthe&amaafBme"nmrwraw<nsal,w(aapmnt Sq.F[. FloorArea Valuation
r O (commencing with Sedan 7000)of Divislan 3 of the Business and Pnret m.Codc)or $120000
y 9 that be is exempt therefrom and the hands for the alleged enomptioa Any violation of
Section 7031.5 by my applicant for a permit subject,the applicant to•Civil penalty of APN Number Occupancy Type
not mart Nan five hundred dollars(5500)
❑L as owner of the property,or my employe"with age u bet,cele compensadan,
wind,thewmkandtheameertrmtsatmendcdaartemdfars.lo(See.7044,Budoev RequiredIns Inspections
YW Professions Cade:The Contractors Lieenm Law date not apply m an Owner of p
property who build,or Improves demean,and who does such weak himself or through his
awn employee,provided that each improvements art not intended or offered fa gala IL
however.the building or improvement 4 mid within am year of completion.the owner-
builder will have the harden of proving that M did not Wild or improve for purpose of
tale .
1.as owner a the Property.am exclusively contracting with Ilceaed ammactan to
comment the project(Sec.7044,Baines and Pso(amdons Cade:)The Contractors LI.
cense Law does not apply m an owner of property who Wilda or impmare
se,thern, d. _
who contracts for such pmjecm with a commomr(s)featured punant m Na Contractor's
I.icmma Law.
❑l ons exempt under Set
� .B k P C for this mason
nor ' /v`'✓"y'�^` Q II'InJ Date
WOR ER'S COMPENSATION DECLARATION
I bemby afOmt under penalty of perjury mu of the following declare irlm
❑Ib..andwillmd.Mi.tceitirmmofcomntwwir-Imumfwwoftescompen-
ation,as provided for by Section 3700 of the Labor Code,for me performance of the
work for which this permit Is Issued.
❑1 have and will maintain Walk's Composition Insurance,as required by Section
3700 of th,Labor Coal.fa dm Performance of wan for which this permit is latad. '
My Worker's Compensation W m=carrier and Polity number arc: '
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
I
(ThisseNan mad ambecompleed if the 1.11 is forms,moment dollar($100)
or leu)
I ctrdfy duet in the performaae of the art for which this Permit 18 Island.I"I ata
employ any perm.in my mmnc as m�Ilxom subjenmll,WmImY Campesudon
Laws of"form n.. :i w
Applinnt
NOTICE TO APPLICANT:IL after making this C,ARate or E,empdon,you dmuld
become&Object to the Warkers Campewdon provision of the Labor Code you mus
.JO formwith comply with such pnvismas or this Permit"I bo deamed,eoked.
ro CONSTRUCTION LENDING AGENCY
[+ 1 hereby drum dust then Is a cansuactime lending agency for the performance of
C>
the work fa which this Permit I.mad(Sec.3097,Civ.C.)
QLenders Name
,7 z Lenders Addmas
tJ Q 1 comity that I haw mud this application and sum mist the above InformNun is
IT, corral I agree to comply with all city and county on inntc"and mute laws reeding m
OU building construction.and hereby mmorim representatives of this city to enter upon the
U abow-mentioned property for impaction purponaL
(We)agree to ave,indemnify and keep harmtea,the City of Cupertino aiaiat
C6 liabilities,judgmenm.eau and expect"which may In my ay actton against aid City
U 2 in consequence of the grsnfng of this permit G iem"
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Sigature afApplicmdC mictar Data
HAZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum building acupantamre or iundlc hmardoa material
as de0ad by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
ode,Section 25532()? ���� All roofs shall be inspected prior to any roofing material being installed.
❑Ya pNa
Will the spplicmt or fuwm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvardna air contaminan4 u dc0ad by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes �Nu
1 have mad the baand.maerials requirements under Clepur 6.95 or the Carlow.
nia Health ASafety Coda.Salons 25505,25533 and 25534.1 understand thus If the Wilding
dons not cummntly haw a meant tort It h my responsibility to madly,mat accupant of tho
requirement,which must Ivens priarm ismmce cnitinceeor Occupsttey. Signature of Applicant Date
� q-6–d— All roof coverings to be Class"B"or better
Ow or or mthonsad"pent Data