05060051 CITY OF CUPERTINO �-�
BUILDING DIVISION PERMITCONTRAC~�TQRINFORMA.TION.-..
BUILDING ADDRESS: YING MLI ......05060051
OWNER'S NAME: PERMIT ISSUE DATE
YIN
NE: SANITARY N0, CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
nOij LICENSED CONTRACTOR'S DECLARATION O O O
m I hemby affirm that 1 an lisvad umlcr provisions of Chapter 9(commencing Job Description
with Section 7")af Division J ofthc Business aml Protassium Code.md my license is
full forte and effem
3'y_ LicenseClas Lie., REVISION-ADDING 60 ' TO GARAGE
a u� Data Contractor ORIG PERMIT $#05030154
ARCHRECI-S DECLARATION
I understand my plans shall W used as public reconis
JbU
ung Licensed Professional
OWNER-BUILDER DECLARATION
<I 1 hereby affirm that I am exempt from Ne Contractor's License Law for the
•O o following mason.(Secuun 7031.5.Business and Pmfccsions Codc:Any city or county
1: which requires a permit to construet,altar,improve,demolish,or repair any swctum
pnmw its issuance,alsura moms the applicant fors«h permit to fileasigsd Rahanot
F s G that he is licensed pursuant to the provisions of the Common's License Law(Chapter 9 Sq.Ft.Floor Area Val 94 5
set_- (commencing withSection7")nf Division3 oftee Busimmand Imalmiom Codc)or
3$ Nat he is exempt Oumfmm and the basis for the ahgcd exemption.Any violation of
Section 7031.5 by any applicant for a permit svbj.,m the applkant to s civil penalty of APN Number Oeeu ane e
not mom Nan fine hundred dollen(5300). p y Type
(,as O,�pf� 37532001 . 00
❑ papeny,ormyemployeu oithwgnastltei(Sec.compensation,
will dothe work,and the structure isnot imet or offeredfar sale(Sec.7014.Bu.
of
and Pmfevioas Cade:The wsthermts ndwhe law such
tort apply lf an owner or Required Inspections
property who Wilds m improves thercogaad who me n such wart himself o lthrough his
own employees,provided that such rat is
id wit am not inreMd moOesW due Owner.e.Ir.
however,the building or improvement is sold within one year ofimpmw far theaseof
builder will love the burden of proving dot he did rot Wild or improve Ire purpose of
sale.).
❑I,as mune,of the progen,am exclusively convaning with licensed coramems to
construct the pmjccl(Sec.7(144,Business and Professions Cade:)The Comment's Li-
ase law does am apply to an owner of property who Wilds or impsms thmend.and
who contracts for such projects with a contractor(s)licensed puieuam to the Contractor's
License Law.
❑Ima m, pt under Sec. ,B k P C for Nis reason
nu `��a-.�s C�Dau 0
WORKER'S CO PENSATTf ION DECLARATION
1 hereby afnrm under pn a ty of perjury one of the following decimations:
❑1 have and will maintain a Cer iGcau of Contin to self.insum for Worker's Compere
cation,as provided for by Section 3700 of the labor Code.for the performance o(ft
work for which this permit is issued.
❑1 have and will maintain Worker's Comperadon Immune,as required by Section
37W of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance earner and Polity numb,am:
Cartier: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu=(am need not becompleted if the permit Is foronc hundred dollars($IN))
or less.)
I cenify Out in the performance of the walk fm which this permit is sued.I shall nm
employ any pe.a in anymanns(so�b Smesubject to the Workers Compensation
laws m California, f C
Applicant
NOTICE TO APPLICANT.IP afur making this Certificate of Exemption,you should
become Subject to the Workers Compensation provisions of the Lahr Cods,you must
.J ,Z fonhwith comply with such provisions Or Nis permit shall be deemed mwked.
Z O CONSTRUCTION LENDING AGENCY
'rt I hereby anirm that thcra is conmmction lending agerrry for ftperfomurne of
C' the work fur which that permit is issued(Sec.3097,Civ.C.)
1 Q Lender's Name
z Under's Address ,
U Q 1 certify that 1 base read this application and sou that the aWe information is
D,F come[.I agree to comply with all city and county ordinances and seats laws nelaling to
Q V Wilding construction,and W¢by audronaempresenutiws of this city to tour upon are
abovcmenudgm pmpeny for inspection which
cans.
F W (We)agree to save,indemnify and keep harmless the City of Cupertino against
h in
egece of thecosuand expuuasrit- may in any way accme against said City
(„)z in consequence of the granting of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4tDate
SOURCE REG TIONS.
7/r/eS`
Signature mAppbcanOComramor J Due Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will use applicant or furore Wilding«cupsnt aom or hardIc hanrdous maudal
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
secmk, yes No 235J2(a)?
0All roofs shall be inspected prior to any roofing material being installed.
Yrs f�
Will me applicant or foram building«ea art arc a If a roof is installed without first obtainingan inspection,I agree to remove
Pp 8 p quipment or devices which P
cart luvardnns air conuminanu as defined by do Bay Area Air Quality Management all new materials for inspection.
District?
❑yes �Na
I have read the harmclommawrials mquiramenu under Chapter 6.95of the Cakfor-
m-Health&Safety Code.Secuoru25915.25533 and 255X.lundcnond thatifthe Wilding
does not currently have a cram.that it u my maponaibility,te noufy the occupant or the
reya- a hicbmuttbcm�c/t®orm'-a--af. romcateof cup y. Signature of Applicant Dale
Own —��r
?alas@onrc agent te All roof coverings to be Class 'B"or better