05110034 CITY OF CUPERTINOp^ '§ x FIEFE�:n _
BUILDING DIVISION PERMIT ��VL�°�•�'�
BUILDING ADDRESS: SEAN 7sHANG PERMIT NO.OS110034
10211 MILLER AVE 10213
_ OWNER'S NAME: PERMIT ISSUE DAM
SEAN ZHANG 11/07/2005
NE: SANITARY NO. CONTROL NO.
ARCH17ECTIENGINIM: BUILDING PERMIT INFO
'REDO EIPCr PLUMB MECH
0 0 0
30o
LICENSED CONIRACTORSDECLARATION Job Description
Ihereby affirm thin 1 aro licensed under provisoes of Chapter 9(onmmcncmil
MWSec9.7")ofDivisima 3mf do Buslnm and Profeaions Cade.aed mylicenscs
in full(arta and ffect.
REPLACE MAIN WATER LINE TO HOUSE
e
kk p�nmtlai Contractor (DUPLEX/TWO ADDRESS)
' ARCHITECTS DECLARATION
1 understand my plans shall M used u public records
�a Licensed Professional
ss 3 OWNER-BUILDER DECLARATION
i I hereby aRrm Thu 1 m eampt from the Contractors Limeam IAw for IIx
c D o following reason.(Section 7031!.Business and Professions Code:Any city Of county
5$f whim regairns a permit In COu L alter.Winnow.EcmolW,or repair any Suriname
.
ito poor it,its W.Me.Amrequires tixapplkmtar such permit ofile signed mlteml Ft. Floor Area Valuati n1000
That he is licensed pursuant
in provisions of six Conuacors License Law(Chapter 9 Sq.
g'y (commencing with Section 700M of Division 3 ai Business and Professions Code)m
e that he s wo mpt the.from and the Walt for the alleged exemption Any violman of ppm �e
Semo•civil penalty of on 1031.5 by any applicant for a permit subjects the applicant 3 6T314 a 0 r 0 0 Occupancy Type
not more than five hundred dollars($4001•
❑L we maw aides property.or my wploy.with wagos as them mk eompmeadon,
will do the wank.and The chromium Is not intended Or offered far"In(Sim-7044,Bumex Required Inspections
FloriculturalandFloriculturalCodw The CoamamaM1 LltaeC Law dMA Ott apply m N awYr of Q P
property who buildamimprovet Wesson,and whodoaauch work hivuelfmtia0aghbs _
own employees,provided Wtweh improvements m Out totaled mofferal for a>k U. RNA bawdver.W Wilding Who lou Improvement s that
within one year of mmpktiaq theowner- //tt[y/� err
builder will love the burden of proving But he did mat adw m improve fie Purpose of (� t1V(/_///"[S}6}tD(('y]
suss).
d T,as"war of the property.am aelwlvely conuaUng with IkeruW rnntractma a /j'
mnstrun Ne projttT(Sec 7044.Businm and Pr"fevioa Code:)The Comaxw'a U• ,ts p
cause IAM them not apply e an owner of pmpmywbo builds or Improves thereon.aid. ^�/p/ • f.'7
who contracts for sons prokcs with a eomosconO licensed pursuant o the Contrmors I/lJV'/lyd(1V V_ O/7�
01antLaw. �� (J
❑Iae"Lov. under Saw --�—� BdPCfor this remsoa
ID
131M.Fthe
ner �4 �• /12Ct 4 Date
WORKERS COMPENSATION DECLARATION C7
I hereby same under penalty of perjury arc of tins following declen0"nx
1 have and will maintain a CeNOatoof Cotmal m elf-Wim far Worime.Conpen-
inn,a provided fm by Samon 3700 of the Labor Code,for W Performance of We
k for which Ws permit Is issued.
1 have and will maintain WorMefs Compensation Insurance,as required by Section .
Labe Com.for We performance ofsix wok forwblm ths Permit s Issued
y Workees Compensation Wunrxn carrier and Polity nmber m:
ller. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thswaton nerd nottica mpsxd lithe permit stmorx hundred Oil=($100)
or hoss)
I certify that in the per(onma co of the work for which this permit s issued.1111411 not
employ my ptsson in any manersu a a beeom�wbjeW dieworken'Compensation
IAwa of California.Data NOW
A .l beds
NOTICE TO APP— UUM`.If,dmr making this Cerditax M A�you aboutld
become subject to We Workers Compensation Provision;of We Labor Cade.you moat
.J O forthwith comply with such provisions a this permit shall W seemed resulted.
? CONSTRUCTION LENDING AGENCY
4
[—i 1 beehy affion dial them is a onrmroetion hooding army fie the performaoo of
ani> We work fur which this perms is Issued(Se.3097.Civ.C.)
OLW Q Lender,Nma '
OL Z Leedee Address .
V Q I certify that I haw read this application and sate that the show information is
Uy ^ co rt I a$me to comply with all city and county willingness all sus laws willing in
O ltS.'J building conwuction,and hereby authodae epmmn m of this City to enxrupnn the .
Liz above-mentioned Property fa'inspection purposes.
(We)agree in ave,indemnify sued Jump hmmkst the City of Cupertino again _
y Ilabiihia,judgmeas,colt and expenses which may be mywy.mue agilnst aid Cry
V 2 in conseet eee of ibe granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RECU�..kTIRN _ ` � t1�_tl$ Re-roofs Q✓l��i'N
Slgatue of Appliliranl/Conumlor L Dm
HAZARDOUS MATERIALS DISCLOSU RE Type of Roof
Will the applicant or future building occupant store or handle hamrdous material
a defied by the Cupertino Municipal Code.Chapter 9.11,and six Health and Safety
add.Sermon 15531(87 All roofs shall be inspected prior to any roofing material being installed.
OYns L n
Wil
the,pp0aantefuture WuOWngoaopantumequipmaardcvim whim If a roof is installed without first obtaining an inspection,I agree to remove
10 emit haadous air mnummants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yd �fu
I haw reed the hnadnuemawrlas roqulremonsunderCMpter6.95 of theCalifoP
n a 1W W @SafetyCodn,Somans USW,25533 am125534.I underawd thalfthe building
data rot currently have a tenant that It is my responsibility W wdfy the W0WPw(of six
mywrel9On>X luc�\w ryetpriar�of a cemrxax a`�an..B� Signature of Applicant Date
Owner
Sarwthmredagent G I I DmAll roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
f. ✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
IS,UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
6u 211-10L11 /�i�ln � Q �no 9.$"D/(L a-r/, t'l
OWNER'S NAME: f1 cwt Z PHONE # 4o 80 173 —/ 3
GENERAL CONTRACTOR — > / FAX #
' �iL
I am not using any subcontractors: S'-O- n2::: 1 l —�" DS-
Signature
SSignature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Sign tore Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
A All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2 A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City, Phone # State License # Type of work to
be-erf ormed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
• portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
_performed
..... .................. penaltyperjury..... : .
................... ...... ..............................................................................................
I declare under ofthat the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Ownei s Signature: 2,r Date: �— 7— 0J
Job Address: o Zf i f ZI 3 M ;� R Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
IT 00F 10300 Torre Avenu
CUPEf�TINO '° ` ( '�73
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Budding permits are not required to be signed by property owners unless they are
personally perforating their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and w have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors,then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensatiorf
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the US.Small Business Administration). -For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Pdnted on Recycled PaW
i
Sl� REPIPE/SEWERS/MAIN
CITY OF CUPERTINO SERVICE
,CUPEf�TINO PERMIT APPLICATION FORM
APN #3/ r Date:
h J Z o _-7 — r
Building Address: 10Z l — toil 3 A (v
Owner's Name: Phone#: h _' i
Contractor: one: ¢u� License#:
Contact: V>� Phone: Cupertino Business License#:
Building Permit Info: i' �cw�1� E> ✓� Q o Coy F�t7
Bldg1:1 Elect ❑ OA Plumb . '•/ vie
Job Description:
Residential Commercial ❑
Cost of Project:
i
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
2, BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING