06050054CITY OF CUPERTINO''
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DIVISION PERMIT
C�NTRAGTQR INFQRMA.TI(QN
BUILDING
BUILDING ADDRESS:
VICKIE PENG & CHENG HSIN
i`A°TND'06050054
R'S NAME:
PERMIT ISSUE DATE
VICKIE PENG & CHENG HSIN Y
N
PHONE:
SANITARY NO. CONTROL NO.
ARCHTfECTYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR untra S DECLARATION
I Maby affirm Out 1 am ONTRA ummr provisions of Chapmr Y (commencing
with Section 7IXMn of Division 30fte Busumas aM Professions Cade, and my Be.. u
Job DeSCi�t10n
immRmmaamd effect.
full f
HOUSE DEMO
L Claza Lie. p
o@PL=
ALE®
Dam. Contractor
ARCHOECI'S DECLARATION
1 understand MY Plans shall he used a public records
JUN' 1006
Licensed Professional
OWNER -BUILDER DECLARATION
1 (Tum Wal I Cmusea
Wm the Camcmes License law for my
I.S.exempt
following ices a etch t Tor I.Business end ProfeWans Code: Any city m county
Maso .
which squires a permit ro construct, slur, improve. tar repair any macro
ipA
Blin
h pastil t
prim m its i licensed me Wfor sucCommerta's LI le A OM La (Chaps int
momenciemN We Conuxwh Haenel hw(C
Sq. F[. Floor Area alaation
puaction7 eA(Dof
pursuant to provisions o
urbe)9
Section 7000) mf r andmpt Profen inns Cade) or
Busaged
exe
$8500
ass
thom a is thertfrom and the basis far the al
that he u exempt basis f alleged uemptima Any violation of
APN Number
Occupancy Type
P Y YP
31.5Pr be
Section 7031.5 by airy applicant for a permit subjects the Applicant to a Nvil puulty of
not mom tan ore hundred dollars (SIM
❑ 1,ssowner o(thep,opmty,amy wployces with wagesss dre'usmle cempewtim,
Required Inspections
will do to work.and rowan.. isnot intended moRered fatal.(Sec. 704, Business
and Profedons Cod. The Commerce, LKenm Law does not apply m an owner of
progeny who Mildsmimprovesthemon, and wbo doessuchwork himself or thaugh hu
own employees, provided War such improvements art ant intended oroQemd formle. If.
however. to Wildingor improvement u sold within ane your mf completion, me owner -
Wilda will have the Matra of paying tat he did not build or improve for purpose of
,
mice
1. az owncr of to property. AM exclusively contracting with; licensed cantrutms or
construct the project (Sec. 1014, Business and I'micasions Cede) The Communist's Li -
,eve law does not apply m an owner of progeny wW Milds or improves tenon, and.
who concocts for such projects with a conuactoRs) licensed penman, a the Conuutors
License row.
❑lam once , nGsSfi . B h P C for this, resson
sibi ��,��� Dare = --0�
WORKER'SC fPEN TION DECLARATION
V
1 hereby Affirm under penalty of perjury one of dm following dcclaruions:
01 have and will mountain aCC rimwo(Co=ntiomlf-insumfmWotkeeaCamNn-
smim, m provided for by Section 3700 of the Labor Cade, for the performance of mm
work far which Our permit is ismad.
0 1 have and will maintain Wmkces Compensation Insurance. az nalmo d by Section
37W of dm Labor Cade, for me performance of Ute work for which tis permit u issued.
'
My Workees Com n
CERTIFICATE OF E)(EMP ION FROM WORKERS
COMPENSATION INSURANCE
.
(Th ssavan Ocad not be Couple" lithe permit u for. hundred dollars (g100)
or less)
I ca rdy mut in the perfarmuoe of dm wart for which mia perms u issued, l shell rot
employ any pononin ymannersuss to become subj$cra u¢Warkers�mpens9
Laws of Cali D
',Plica. M .AG Is/./moi— / 1 •�
NOTICE TO APPLICANT. If, itr 'ng ON Cenificam of Exemption, you should
become subject a We Worker's Compensation provisions of the labor Come, you roup
comply with such prmvisimu or this permitshall W Claimed rrakcd.
CONSTRUCTION LENDING AGENCY
hereby M. that tem u a conswction lending agency for to performance of
m e work for which this pcamir U excited (Sec. 3097, CO. C.)
Leaders Name
LmAara Md.
1 certify that I Aare rod Nis application utd eau War the above Warned.. is
cmrtct. I agree m comply with all city and county aNinsnces and sure laws relating to
building construction, and hereby authorsa apm-xdrIiwA of tis city m enter upon me
above mentioned Property for inslieetian Mrp0us.
(We) agree a save, indemnify and kap harmless me City of Cupertino against
liabilities. judgments. cru and expenses which may in any way amus against said City
in eonsegmunce of the granting of this permit.
APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:
SOURCE[
Date
E�l1LA N` ` O
1A
Re -roofs �--
Signaturt of ppliamrCon Oaf
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or for= Wilding Occupant store or huW m havNous material
as dcRned by the Cupcnino Municipol Code, @2po,1.13, and the Health and Safmy
e. section 25532(+)7
❑Yes pfNa
All roofs shall be inspected prior to any roofing material being installed.
Will thea ecam,or future Wilding «ca nt ux crudity devices ch
PP 8 eA
If a roof is installed without first obtainingan inspection, I agree to remove
Pe g
emit hvaNnw air conuminanu u dchaM by the Bay Arta Air Quality Management
e Air
all new materials for inspection.
Disuicti
❑ Yu u
Him read We WsaNeusmaurials aytimmnts eunder ChaPmr695mfineCalifor-
maHexlthkSafclyCode,Scanne 5505.25533 and 25534.1 untriand on ifthe Wilding
does nm currently haste o unanc mat it is my maponsibilimy m notify IM Oc,upant or me
mgoirements which Most C=I prior in issuance afro CadUam of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner oramthori,edagent Dare