05060050 CITY OF CUPERTINO POW
BUILDING
BUILDING DIVISION PERMIT gCC1NTRA,G�'C1T2. N�.U,IO;R ?1:�YQ1!� ;W
BUILDING ADDRESS: YING LIU PERMITNOO 5060050
NEWS NAME: PERMIT ISSUE DATE
YING LIU 2005
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ear86 LICENSED CONTRACIOR'S DECLARATION Job Description
1 hereby aMan Oat I am Bawd andem pmviuu mof Chapumcnc
r 9(coming
n; with Section 7")of Division 3.r saw Buaines and Pra(etsion Cas,and my Reeve is
in full foceand effect. ADDITION-MS .BATHRM (.184 ' )
j V1? Lkew Class l.c.0
Data Contractor ADDITION TO MAIN HOUSE
q ARCHITECTS DECLARATION
22 I understand my plans alWl k Sad as public records
In
a,
C Licensed Professional
OWNER-BUILDER DECLARATION
1 bewhy afsect on I e1.,Business
from the Canlnctor'e :Any c Law for the
which tax noun.(Smith 713 L5,Bualoss and Improve,
demolish,
em li Code:Any city at county
$!a which requires issuance,permit re mnancL alter.nt for su d Permit,care Sig any mtuelum
Yom+ pilar w iu censedFurman,to resme the
ovisio s,of Oe Cch gamin w ecce sLaw(Chkmcnt tk)b 2 9 9
< that mencin withSeumllatheprovlaionoftineComsiness UawUw(Chapur9 Sq.Ft.Floor Area Valu$
$
'at he
h ection refrom and the
Division 3 of the eg Business mtl Proon.Any
Cadc)of
.. that he la exempt therefrom antl Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit ubjects the applicant In a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
37532001 . 00
0 I,as owner of the properly,or my employcca with wages u their Sale comw
petion,
will do The work and the atncture It notintended oronered forsale(Sm.7014,Business
and property
Cade:The Cont canna Licew law don not apply lf an oww of I1�Inspections
own eay who s,provided Oat
sch Impr and who da eanhwarthimullmthrough his
own employees,the iprovided thatvemlmprowmanuaremyearn lsol fcar.Buetl Intme sale.H.
Wilde,however.the Wilding or improvement is sold within am year of completion,the owner.of
Wilder will law She burden of proving Nat k did not Wild or Improve fm purpose of
=to.).
JAIV
0 L u owner of ct sec.7property..B news and contracting with licensed envscsn i- (� �'1 fY �Z
meso the project arty.s an Business and ray wh tan Cade:l The Ceharq.fa ed (*(�[✓]J(q B ,t7o�0
Li-
made law dean not apply w m owner of progeny who Wilds or improves Norton,and
who contracts for ash projens MO a contncwr(q IIuwO punnet in use Contnnofa
Lkew Law. (
0l am"am l oder See .BkPCfa than won y
w Das
WORK OMP LION DECLARATION 41
I hereby LM m untler perWty of perjuryane of the following deelae mom
0 I kw and whl mainuin a CeNamm of Covent wolf-inure(or WortefaCamMn-
mion,as provided for,by Section 3700 of the labra Code.for,the performance of the
wort for which this permit is issued.
0 1 ban and will maintain Waker's Compensation Insurance,as required by Section
3700 of the labor Code.far the performance of the wok fa which this permit is issued.
My WorkeYs Compensation Insurance carrier and Policy number are: . .
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu Section need not kcompleted Irthe Permit is forou hundmddollara(5100)
or less)
1 madly Nat In the per(nrmmm or the work for which this permit Is issued,l shell not
employ any Formal In any meaner an u to become subject to On Worker'Compensedon
Lawa of Ctlif.mia.Data _
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject in the Worker's Compensation previsions of On la1wr Code,you mus
O O for wive comply with such provisions or this perm(shall be licensed revoked.
ti r�.vCONSTRUCTION LENDING AGENCY
(.r I hereby affirm Nat Nen IS a cmJdamdnn lending agency tot the Mtfammmce of
a the wank for which this pnmh la issued(Sm.3097.Civ,C.)
WW❑ Len Ices Name ,
0Z Iendefs Address
U0 1 ceN(y that 1 have read this application and sus that the show informationla,
U.`• carmen,I agree in empty with all city and county onliwces and sats laws resting in
0 Wildingconstruction,and hereby authariu repreunutivn of this city to caul span use,
W ahmemmtioned property fa Impecdon purposes.
LL (We)agree to saw,indemnify and keep harmins the City of Captain.against
N liebilitin,Jutlgmenu.seat,and expansion which may in anyway:rase againtsaid Cly
U7 inconsequence aide,&=tin&of poall.
ri APPLICANT UNDERSTANDS �D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU RER(:Fj GULATIONS.
fyf�w-1�� Re-roofs
HAZARDOUS
Signwurt of Applimr Das
HAZARDOUS Mding occu DISCLOSURE Type of Roof
Will OeeCupertn town Wilding eccupant mom orkMsh adlhanmaterial
sa defined by the Cupertino
My dpel Cade.Chapter 9.13.rail the Health rail Safety
We,Sccu.n 25532()7 All roofs shall be inspected prior to any roofing material being installed.
0 Yn e
Will the applicant or nus building occupant w equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cell hnaedaus air came is dcOncd by On Bay Area Air Quality Management all new materials for inspection.
DisHlcl7
0Yn No
Ihawandthehna Imsmawtlalsmqulmmenuunder Chapwr6.95oftheCalifor-
aiaHcollh @ Safny Cpptlticc Sectiw 255()5,25533 and 25534.1 u.demsund thRif0c Wilding
doe not cumcmly t.sheat,Oat It is my p krsOitity w notify the occupant of the
requirements which Ibemet Wu ar a Certificate of Occupancy. Signature of Applicant Date
Owner or authorized agent Dow All roof coverings to be Class "B"or better