05090110 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTnR INFORM�.TIQN
BUILDING ADDRESS: WELKIN INTERNATIONAL IND fASITND'05090110
7811 ORION LN
.R'S NAME: PERMR L4UE DATE
TIANLHUI TEMPLE 19925 STEVENS
NE:
SANITARY NO, CONTROL NO.
(408) 252-3396
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB NECH
i o o LICENSED CONTRACTOR'S DECLARATION lob Description
u 1 hereby art=Oat 1 son li¢nsed under pmvisiau or Chapter 9(commcaing P
with Section 71)(10)a(Divison 3 of the Business aM Professions Code,and my license is
+ „ ;nmRfor¢andefren. REVISION--REMOVE TRASH ENCLOSURE,
Iqz Lima. Lm." ADJUST PARKING STAUS/CEILING FRAMING/WALL
Dam Contractor
°m9 ARCHREC SDECLARATION NO NEW PERMIT ISSUED/ORIG. #04060040
J1 a i 1 undersand my plans shall be used as public wearda
W
oat, Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby alum Nm 1 am exempt from On,ConoazmYs[Jeans Law for to
p o following nasal.(ScNmn 7031.5.Busiass and Prolon io.Conk:Any city m..my
m which requires a permit to eonar¢a.slier,improve.demolish,ar spur my structure
-iy priar an iu issuance.also requires the applicant rot such Permit to file a signed statement
FSC Out houlicensed ..I an the polis;..of due Cou'was"e License Law(chapter 9 Sq.Ft. Floor Area Valuation
em-$ (comencnringwitinSection7000)ofDivesmn3orOeBasin=andProfesimaCode)a $175
_ Out the is exempt tlemfmm and dae basis for the alleged eaemp tan.Any violation of
Section 7031.5 by s ,,applicant rest a permit mbjeca the applicant to a civil poselty of APN Number Occupancy Type
not mon arms row hundred dollars(SSW).
❑I.ss woof ale popaty,amy employs w'dh wg.ssde'v sole compenati.,
3 62 will do the work and the mnesure 4 out intended a offered rot aak(Sec.70".Business
Required Inspections
and PmfcWo.Cade:The Contractor's LI¢.e raw ds e ns not apply to an owner of q P
property who Wildsmrimprows therson.andwho doessuuh wort hhnselfor tiuuughbis
own employs,provided Nat such imptowmmm are not imeMN aaRerrJ fatale If.
b wewr.Ne building or improvement is said within a¢year of compledon,On owner-
Indoor will hoe One burden of Moving Oat le did on,build or mallow for purpose of
ale.).
0 1.as an=of de property,me exclunwly contracting wit licensed mnuxmm to
construct the Project(Sec.70th.Bum.and professional Cade:)Tho C.Vam.ra L;.
cense taw ds not apply to an owner of propenyvvh.Wilds or improves daemon.and l
who¢mmcts far such pajama with a con rs boa(s)lica.cd pursuant to the Comuseure,
License ,
exe
0 1 am mpt under Seo. .B k P C fa this rt.on
(f.by
'SCOMPENSATIONDECLAR ATIO4
I bermMra ty of perjury roe or the following decluenfi s
Ihsw pm,vCatif mofCeLaborCode.farOnMdkcraCampo-
auon, r pmv ¢tisn 1T110 a!to Lahor lode.far the perfonnarh¢of the
wale tor wnic a;ssued.
0 I haw art0 Warker's Compensation Iwnntt.Is required by Section
37W of the Labor Colo.fa Ne performs¢of the wart fa which this permit is issued.
My Workers Cmmpe.adme insurance carina and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu semlm¢ed notWoomplemd if ale permit is froom hundred dollars(SIM) -
nrleu)
1 cenih tial in the Performance of mhc we �l ich Nis permit u issue4 I shall nos
employ any Arson in my m.nncm sobjecUo art Woheri Co.notation
Laws of Califomia Dae
Applicant
NOTICE TO APPLICANT:1,afmr making this Certincane of Exemption,you should
bane so b the Wo a Care assume
pmMom of the labor Coda,y
Z r.Mw;thcomply with sal —wfi..m Nuprmil.Nall1d¢medmwkad.-a-
0
Z O ONSTRUCTION LENDINGAGENCY
E Thor whicthy h sew then mW Wood(Sec.
agency fm the pertormaacof
C the work for which permit u issued lSuc.J097,Civ.C.)
�W Q LeMer's Name
z LcndIeIAdd.
V O 1 ccnify,that 1 haw read this application and sum aa the show information is .
Fcomms.1 agree to comply with all city and county ondi.ns and rote laws rtladng to
0 V building convection.and hereby mthorice repromnmuwsofthis city to emerupnn the
F 4 mew-menuo¢d property for inpcuon purposes
(We)agree to sow,indemnify and keep harmless the City of Cupertino agai.t
T/1 liabiliti.,Judgments,casts and expnms which may in any way accrue amus sold City
U Z in eo.rqum m of the grand,or this pamit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE a0—
REGULATIONS.
fle-roofs
Signature ofApplicanUCan ver v Dem
H OUSMATERIALSDISCLOSURE Type of Roof
Win lW appli tell
or ruturt Wilding ampmtvomahandlc 7uaNausms¢sial
dressed by the C norm Municipal Code.Chapter 9.11.and the Health and Seely
a.Section 155 (a7 All roofs shall be inspected nor to an roofing material being❑Y. ❑N. P P Y g g installed.
Will the app kam ar futum building omopam ase aquipoent adevis which If a roof is installed without first obtaining an inspection,I agree to remove
J
7Dishict?t follmm.air c muminanu a defined by the Bay Area Air Quality Managment all new materials for inspection.
DY. ❑N.
1 have real the Wundo.materials lequncmcnm underChapterd.95 ofmhc Califor.
ealth@ SuctyCodc.Satiate 15505.75533 mdl2i53d.1 underaM thaiflM buildingl nos currently haw a m.ns tut itis my mspomibiliny M notify the occupantof Or
ummcnts which muuho 'ors Wuam¢ara Can;ficam of r3capanry' Signature Of Applicant Date
<-Toa
Owner or author' agcm All roof coverings to be Class "B"or better
Dam' '