07120102CITY OF CUPERTINO -
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CONTRACTOR
BUILDING DIVISION PERMIT
INRORMATIOIY
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BUILDTbVISssMERRIMAN RD
C&S CONSTRUCTION SERVICES,
PERMIT NO.
07120102
R'S NAME:
PERMIT ISSUE DATE
ZHIHONG LIU
43575 MISSION BLVD STE 629
02/28/2008
E:
SANITARY NO. CONTROL NO.
(510) 402-8422
ARCHiTECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EIF.Cf PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
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1 hereby affirm that 1 am licensed under pmvisiens mf Chapter 9 (commencing
with Section 7W0)of Division Jofd,e Bumeaand Profession Code, and my license is
REV.TRUSS CALLS ORIGINAL PERMIT # 07030227
in full force and effect.
License Claw t2.I
Dam Contractor
ARCHITECTS DECLARATION
1 understand my plans shall he used as public records
Licensed Proksawvl
OWNER -BUILDER DECLARATION
I tomb, affirm Nat I am exempt from the Conveners License law for do,
following reason. (Section 7031.5, Business and Professions Cale: Any city or county
which require a Permit to convect. alms, improve, demolish. or repair any structure
prior In its issuance, also requires the applicant for such Permit to rile a signed sure tom
He Contractors Lienee Law (Chapmr9
Sq. Ft. Floor Area0
Valuation
that he is licensed pursuant to am previsions of
(commencing with Section 7000) of Division J of the Business and Profrsairms Codc) or
that he is accept diumfmm and the basis for the alleged exemption. Any violadon of
---i-421603 Number
Occupancy Type
Set: 7031.5 by any applicant for a permit subjmas the appBeant m a civil penalty of
nes mom than five hundred dollar (5500).
not
lA
0 1, as owner Oldie property or my employees with wage as their auto cmmpensadon,
Required Inspections
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will do mewosk,and lheswcture unotimnded ereQered forsals(Sec.7044,Busiws
and pmfesalons Code: The Convalesce, Liable law does oat apply to an manor of
property Wilda mimproves Hereon, andwbmdasauchwork himselforthrough his
own employers, provided that such improvements art not inutldM maRered for sok U.
however, the Wilding or improvement is mid within one Your of completion. the owrrcr-
builder, will have He burden of proving that has did not Wild or improve for purpose of
1.1.
1, a ower of the property. sen "elusivelynd convening wide Ikmmd contractors i.
IW project (gee. 7044, Business and Li -
who ns Code:) TW Cs
sheacmrs
erinLconstruct
ave law ciat not apply to of Property veld Wilds or improves Hetmn. and,
trmpenY
who convects far such projects wide a mnurtor(s) licensed Imported In IW Contsunoh
a with
Liconest
❑lam escmpt under See .B&PC Ter Hu n
er Dake OZ
WORKER'S COMPENSATION DECLARATION
1 hereby atoms order Notably of perjury mm of me following decWviau:
.
0 1 ham and will maintain s Certifiake of Consent m self-0nsurt far Worker's Cout
cation, as provided fm by Section 37W of the Tabor Code, for the performance of the
work for which this permit is issued.
0 1 have and will mainuin Worker's Compensation Inatio nee, as, required by Section
3700 of dm labor Codc, per One performutce of tis, work for which We permit u issued
My Workers Compensation Insumme artier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section treed not W completed itthe permit Is foram hundred draw ($1001
or less)
1 modify Het in me performance of He work fa which this permit is issued, I shall not
employ an rson in m mannerm a1 m bI' use Workers Cnm tuatlon
y
Lawsof Calif
Laws D
pplicant
Applicant—
NOTICE TO APPLICANT: IL a0cr making His cordiiicam of Etcmptimn. you should
NOTICE
become subject to the Workers Compensation provisions of the Latham Coda you mum
'
v forthwith cmmply wide such provisions or His permluhall W damcd revoked.
CONSTRUCTION LENDING AGENCY
I hereby that mem 4 s mvwction lending rgettry for Nes Performance of
which
dueLe wok for which His permit is issued (Sec. JW7, Civ. C.1
Lender's Name
Unities Address
I certify mat 1 have need this application and sum that the W. infmmatim is
comeeL I agree to comply with all city and county o d names and sure laws relating to
building construction. and hemhy authorise representatives of this city to enter upon IN
above-mendnned pmpcny for inspection pmpoes.
(We) acme to save, indemm fy and kap harmless the City of Cupertino against
eeI liabilities,judgments, costs and expenses which may in my way accrue against said City
in comeaguena of the granting of this Permit.
•' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N -POINT
Issued by: Date
SOURCE RE LATIONS. �,/
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Re -roofs
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Type Roof
Signature of Applimmu Contracum IDom
HAZARDOUS MATERIALS DISCLOSURE
of
Wier dtc a nt m future ips�ding sense m hurdle material
'
k, Chapt Heallov
u dcfmed by IW Cupenina Municipal Code. LTapmr 9.12. and IW Healon aM Safety
Cula
, Section 755324)7
Gyro PONo
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Will me applicant or future building maupani use equipment or devices whim
emit h.mc. air cmismivnts a defined by the Bay Arta Air Quality Mmagement
all new materials for inspection.
District,
oyes KN.
1 have read the hamrdms materials ropercmenu unde,Chapkerli.95 of dm Calif.,
ria Health&Safes,Ccde,Saumo25505,255JJ and n5M. I understood lhuiflW Wilding.
does not currently hoc a tenant, that It is my responsibility in notify the tccupmt of de
requiremcn ch m=m me, larks, mlssum.of. Ccnifica�fOccypagqy,./ r
Signature of Applicant Date
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All roof coverings to be Class "B" or better
Owner er awhori,ed agent Dam -