04030167 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON T_TTLE
MING ADDRESS: ""'04030167
C)c;l PT7.MnRPrAqT ANTR
NER'S NAME: PERMIT ISSUE DAM
NAN-CHIANG CHANG
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BUILDING
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CONTROL NO.
NE: SANITARY C
nTZrMNGlNEUR: BUILDING PERMIT INFO
BLDG MECH
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B96 LICENSED CONTRACTORS DECLARATION
�dc I wroby of that I are licensed under provisions of Chapter 9(commencing Job Description
IN full
Section 7OM).fDM.1.0 3afth.Busmemand professions Code,and my license Is
or c ul fews,and offset. SFDWL-1 STORY (1964 SQ. FT. LIVING SPACE)
res
Diga Licemenclaugs LIc.#
L
Date
Date contragetur GARAGE 441 SQ. FT.
ARCHITECrS DECLARATION
U I understand my plans shall be used an public records
it Liommed Professional
OWNER-BUILDER DECLARATION
I hereby 4111M that I I.sucoup,from ft Coneacor's License Lew for the
p Following moan.(Section 703 I.S.Business and Profession Code:Any city or county
ISO! which resign..Permit In.1111ACI,alum.suproft.demolish,or repair any moutime
=j� pdce to its issuance,&M mt,ume;the applicaus,for such permit on rite a signed stsucromn
Nat he is licensed pursuant to dre,Provide"or the concracum's uccess,Law(Chapter 9 Sq.Ft. Floor Area Va"b�M 0 0 0
(comennex.c4a with Section 7003)of Division 3 of ft Business and Prefections Cruel or
that he is meet therefore and the basis per des alleged exemption.My vialatfort of
Session 7031.5 by any applicant for a Permit subjects the applicant to.civil penalty of APN Number Occupancy Type
net...man fien hundred dollars(SSW1
0 1.an owner of the property,on my troployces with wages as their=Is commendation. 37533035 . 00
will do the work,and the structure is rum intended cur offered for sale(Sec,7044.B..I.
and Properelons Code:The Contracter's License Law does out apply us an owner of Requ e ions
property who buiIchor Improves,linemen.and who does such work himself ser through his
own employees.Nodded Nn tech Improvements art net intended or offered for gain.If,
however.the building m,Improvement is cold within one year of completion,the owner. 41
builder will haw the burden of proving that le,did wn build or improve for purpose of
arl..)
iz(f.as ownr of the property•am exclusively contracting with licensed contracturs,us P40
rm"Uwa the prelim(Sec.7044.Business and Professions Code:)The Contractors U.
does not apply te an owner of property who builds or bropmrses Nemo.and,
wOs
ho contracts for such projects with a contingents)licensed pursuant to the Connisoctor'.
Lk..Law
0
der
R JKS 1,
❑I.gxc�pt dcr� ,Bk Pcouthis
exempt
Date rd
ORK ]ON DECLARATION
P.
I hershyfarer. pcoudly.fixerjory cang of Ne fiellown Ii.
I haw and will removal a Cerdneme of Co..[M atir-insure for WOfteS Cturpeces,
Is provided for by Section 3700 of the Labor Code.for dang performance of the
for which this permit is issued.
II pave
ve and will maintain Workees Compensation]now=.Is required by Section
3700 of the tho,Code,for the performance of the Ingric for which this Permit is Issued.
My
We
y orlan't Compentarm Insurance carrier and Policy number am:
Carder.Carrier.
_Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissooloo need nothecompletud if the pered,tsforms,hundred collars(SIM)
or Was)
tenify that in the pert en of the work for which this Permit 4 issued.I shall not
umpt.yany pe an Qi a m become subjectus ft W.AgergCompensation
got Cal
z WplianI TO APPLICANM If.after making this Cerflactor of&motion,you should
) us We Workers Comircrusation patodsongs of ft LAW Code,you must
ffi c re=ply with such prevision or this permit shall N deconcill revoked.
z 0 CONSTRUCTION LENDING AGENCY
4 1 emery,am.that ft.is.ementuractim,i,sudirs agatuy I.the pcdcongersee or
> the work for which this Permit 13 issued(Sec.30G.Civ.C.)
W E5 Lender]Name
Z)z
06 Lenders Address
J 0 1 certify that I haw mad this application wrd smic that the show information is
ILI lorm"L I"we W Comply with all city and county ordinances and state laws totaling to
0 building construction,and hereby autiodne representatives or this city to enter upon the
'how-mentionsul property for inspection purposes.
py (We)egress Io saw,hulcoudry and keep hingless,ft City of Cementiner against
I,, lbabilling.j.dgreents.curso,and c.pauum,which may I.any way....g.mm said City
n Iccipf 0 8 &of Lhispeoleft.
SOUR MERLATIONS.
on" on ZMAON, NO WILL COMPLY WITH A INT Date
L) 'AcPLCAn' DaR Issued by:
Re-roofs
can It`V
sitt9dr.of lion Dup n C/
InA, , -MATERIALS DISCLOSURE ' W /
r,S E' Type of Roof
Will ft Lppligkq w future building occupant rotoor handle h-andens,material
.deflnedbyOar CuunroMunni Chapter 9.12.mol do Hatth and Safety
ScotianV? All roofs shall be inspected prior to any roofing material being installed.
0y.
Will the applicant. r too build' :upant use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
to or
mit ba'Ard.usawcommulmorasaid. d by ft Bay Area Air Quality Management all new materials for inspection.
rict?
[]Yes �o
I have mad the hvsrd,,.s materisisrequircrocnin under Chapter6.95 of the Califor.
maHeAU&Sof y , dons 25505.25533 and 25534,1 tonicnaged that If ft building
does net to I ve.torund,that It is my maponsihnItty It,non.11y Up occuper,or the
.roustlao2rorguesu...f.Certificate 0 Inc Signature of Applicant Date
A - 9
Owner.malourt.cl qAll roof coverings to be Class"B"or better
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