01020052 CITY OF CUPERTINO
IkD",D^:r'D1VISION PERMIT CONTRACTOR INFORMATION:
HUI LING AfiF,SS: PERM I r NO.
RIDGE AV 01020052
OWNER'S NAME: APPLICAI ION SUB DSI 1;
CIS 02/12/2001
490 IONi: SANITARY NO. CONTROL NO,
OzZ ARCHRECI'MNGINHER: BUILD GVERMIr INFO
ISLUC IiLEC PLUMB MECII
<v C I -J CJ I --I
n i LICENSED CONTRACIOR'S DECLARATION .lob Description
Z=e I henbv ofrinn,ha 1 am licensed under pruvisinm el'Chapmr 9(cenmmncing
-rr,g-s with Section]UXpafDivi.,ion)ofdW Busince,wad Profes.inns Culeund my license
r x== i.in fan force and effect. SIGN
Z..< I-wenx Clasc Lic.a
O a O Dam Cnmme nr
F ARCIIII'T:CCs DECLARATION
�:+.C i' I anJmmnJ my plain.M1all he awl n.public rettrN.
Eby-
u x p p Licensed padeoional
W OWNER-BUILDER DECLARATION
to I heathy affirm that I am esurn,p.to the Cunwaur a Li¢nw Laxter,hc
s_Z folLnving rtawn.section 7031.5,Businas.and professions Cale:Any city or county
which"um,a ..it er am.uoa,after.improve,d9mdi.M1,o'repairany unicmre
a3s
Mor to as muance.also nWulms,he applicant rim inch permiuo rile a signed sm, i
.ma,he inlmcmelpamm.no,hepow..ions ofmcConlmctnrsLwenseLaw(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section]01101 of Division 3 of the Business and Pm&.sion.Craft) 8 0
or that he is exempt mertfrom and the basis for the alleged exemption.Any violation
of Section 9031.5 by any applicant for a permit suhjens the applicant In a civil penalty
of no,mem man rive hundred dollar.(5500, A PN Number Occupancy Type
I,as owner of me property.nr my cnnploycex with wages.as their sole conrp6sation. 71 FXIGL7133. 00
will do the work and the swcture is nut intended or offered for sale(Sec.7(w.
Busincas and professions Gxi,9'he Centrvemr's Llcenw Law docs con apply In an Required Inspections
orr of pmpeny who Wildl o,imprme,Ili,,,,and who docs melt work hinueli
through his own,cindo c.s.provided that such improv<rn,na,me not mended or 101 — FOUNDATION
onernl G,f sola If,however,rhe building or improvement is sold within one year of
,nid6i ,,menw„erbmldc,wisehavedWharlotmp,o,ugmathedidnoIbuilm 1.03 — UFER
tom"
In PmTow
1.a r11 .....ty 1 : y r e 'd f I r a If,
104 - REHRR
11 n ,In p j t N 9041 n - d I r.: C a 19i r , „r. 105 ANCHOR BOLTS
I,d nwwl „v,.n rn'1.l ht prolen,o win la.lo i� oni.li wen.d,or,ao it lr n,o 304 — ROUGH ELECTRICAL_
Qmhuumrs Llec L., , c
❑I:nnnexn,,,,I,n �' ' — BmPCi... his-1i„ 5"" FINAL ELECTRICAL
Ow„ Da” "25A . — FINAL_ PUBLIC WORKS
Kde, calf, E mrUI N HCI, IN'1 UN WOO*
I hcmhy:n Gan unJc peml,y of Pcrjnry one ul the Inllowing decl;n;nions: t � .
J h:ry and will maiataiu a Cenifcum of Cmo.cnl Io red Ghnat'e for Worker'% t—
Gnnpcn.miun. u5 provided Bur by Scnion 3900 of rhe Lahor Code. to, the v �
nefamnancc of the work lin which this wirion is issued. C%
❑1 have nod will nainmin Wo,ke,'.Cmuc,r,:nion In.unmac,as mynired by Sccuon
39W it the Labor Cole,for the wrlin...on.of,he work Ga which this Icaair in
issued.My Worker's C'ongsnsation Insurance carrier and 1'd icy number are:
Carrcr, Policy No, \`
CER'f119CA'1'ION Of'EXEMPTION FROM WORKERS' cD
COMPENSAnON INSURANCE r /
I lois section need nut be completed ifine peU
permit is fur one hundred dollars
($100)or laccl IL
1 sonify flu in the performance of the work Ila xhich this pcm,it is issued,1 _
shall no,employ any person in any manner ser as to Maonm subjm,in the Workers \ U
Compensation laws of California.[)am
Applicant
NOTICE to APPLICANT:If,ane'making this Certificate of E.wmpump.you should '
!creme subjectto the Worker's Compensation provision,of the Lawn Cale,you am.a
O forthwith comply with such provision or this perms,shall be elevated rooked.
z _
F, CONSTRUCTION LENDING AGENCY
> I hereby ffin.which this pthemerm is is wed(Sec.
leading agency for tM:performance
of Leaders
work me wM1icM1 this perms,is wed ISw.J(19r,Civ.C.)
S Q Lender's Name
D Z L:nJcr'a Address
l..) C 1 certify that I have read this application and%rare that the able information is
tz tri correct.I agrt9 In comply with all city and county ordianem and state laws relating
U ,o Wilding comamction.and hereby emhorvc repfesenal4cs of this city to enter upm
> t:`. ,he above-mentioned pmpeny for inspection parpmcs.
F., b
(We)agree In save.inJenmify and keep humorless the City of Cupertino again.,
'l) liabilities,julgrctil,aosu and expenses which may in any wvy creme against.Said
U z Ci,Y in can yuvn tat ting nfthin lour ori,.
APUUCA 1.D E STAN SAND VILLI MPLY WITH ALL NON-POINT Issued by: Dale ` S I
��`��,
signmum oro plic HAZARDOUS
Dale Re-roofs
HA%AR muUS MAniRIn LS DISCLOSURE
hRE
sod due epphr norm Muni hipal Co occupant.mom or hamue h...,danmaterial Type of Roof
m de Sed M'the Cupcnino Municipal Code.Chapter 9.13,and the Ilcahh noel Safety
Code Section Scnion 25532W1'1
❑Yen ❑No _ All roofs shall be inspected prior to any roofing material being installed.
Will lie n."I... orNone ldiogocernpam useeyni,nenlo dcvi.r.which If a roof is installed without first obtaining an inspection, 1 agree to remove
nail h:varJous air cun,uminnnu as defined by me nay Area Air Quality Munngnnanl
ionic,^ all new materials for inspection. Applicant understands and will comply with
❑Yes ow, all non-point source regulations.
I has mad me bslmloa.mweriaw rerjaircuocnu under'Chapter(h95 or the
California ilc;dlh h S;dcty Cud,Sertiu s 25511.5,25533 and 25534,1 wWerahmd Thur
ilme Win, ,en m„anrmnnry l,nnv9 tin ten,;ran,than hi.nny rennonsinihty to unity ore
ocean:rel n m ayuirc""nl be Qat,prim m Ixarnme ul'a Cenilierte or
(Lor; vim.,_ Signature of Applicant Date
uwn.�'mmdbodaeduga,, - 7i Z.. All roof coverings to be Class •Bur or better
OFFICE
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