06010146 CITY OF CUPERTINOs
BUILDING DIVISION PERMIT �CONTj"CTOR INEOR�MATION_
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BUILDING ADDRESS: PERMIT NO.06010146
18635 RALYA CT
OWNER'S NAME: PERMIT ISSUE DATE
XINLIN QING
IRV ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Boa LICENSED CONTRACTOR'S DECLARATION lob Description
r m❑ 1 hereby affirm that 1 Am Iicnsed under provisions of Chapter 9(Commencing
ez with Section 7")of Division 3 of Jtc Business and Professions Code,and my license is
n in full force and Affect. ADD 42
D 7 ' -BEDROOM/REROOF (E) /ADD NEW ROOF
License tic." RELOCATE KITCHEN/DINING ROOM
afp Dau
7W ARCHffE DE or
DECLARATION
< I uunderstandunderstandmy Podused
mts shell be testi u public records
JOU
goy Licenced Pndcssional
3 OWNER-BUILDER DECLARATION
COC 1 reasur o(Om Nal 1 1. exempt from the Camp.Co :Any c taw for the
a O following umss a(Section
71D I.S,Business and Pofcstiues Code:Any city or county
<m
which requiMa issuance.permit to cures the,alar.impms u h Permit t,nr e a sig any t tement
ZFC thatme
prioMiteensepursamto Rx the applicant for Conuarmi's Ueese Laed w(Chap statement
Natbuiscing with Section
to the of Division
of thehe Busies Li Professions
rof Law(Chador9 Sq.Ft. Floor Area VaF7dttb1685
Z
�� (commettixem iN Section and t f basis f r the
Al eged cv are Prnfuts vi Code)or
— Net he u exempt therefrom and Ju buts for Ne alleged••^mption.Any violation of
Section 7031.5 by 3"applicant for a Pemlt subjects the applicAnuo a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(S50o). 37525006 . 00
I,u owmur of Ne property,ar my wploycu with wagsu Mev sok eompewtion,
will do thn work.And theswmure is not musuccdaro@rod forsale(Sec.IOU,Busimss Required Inspections
And Professions Code:The Convector's License Law don toret apply to an owner o! q P
property who builds or improve thereon.And whodaessuchmarichimuch o,Wough his
ownemploycs,provided Nat such improwme s Are not intended oraRertd for We.If.
hmvewq the building or improvement is sold within one year o(compledon.Ne owner,
builder will have Ne burden of pmving Nat M did me build or mprose for purpose of
sale J.
1,as Owner of the property,am exclusively contracting wit licensed contracmm N
covmcl Ute project(See.7044,Business and Professions Code:)The Contrxclar's U.
cove Law does not apply to an owner of property who builds or improves Merton.and
who contracts for such projects with a contractor(A)licensed pursuant to the Contractor's
Lkcnse Law.
❑1 am exempt under Seg B&P C for Nis Masan
Owner 6x_ IT on.
WORKER'S COMPENSATION�DEC.DECLARATION
1 hereby affirm under penalty of perjury,are of the following declarations:
1 Mase and will I.b,n OCC.37M of Covera Code.
sure lar Worker's Comp cm
satian,r pro h thi fm I Section 3700 of Nc Labor Code.(or the performatue of One
work for which Nu permit is issued.
❑1 have And will mainuin Worker;Compensation Insu ..As required by Section
3700 of the Labor Code.for the Performance ofthe wort for which this permit is issued '
My Worker's Compensation Insurance artier and Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
This section need not bu compleMd if the permit is(Drone hundred dollars(SIM)
or less.)
I cerufv that in the performance of the work for which this Permit is[Acted,l shell Act
employ any person in any mamursoumbttamc subject t¢the Wohcri ompensalon
Laws of California.Dau ✓ 1 1 t D f-
AppBam
NOTICE TO APPLICANT.If,after making this CcNnc of Exemption,you should
become subject As the Worker's Compensation provinces of the Labor Cade,you most
•,. O foMwith Comply with such provisions or this permit shall bu denoted rewked.
E'er CONSTRUCTION LENDING AGENCY
[—�� Iberehy.M.Nat then its construction knding ancy for the perfomana of
E
du work for which this permit Is issued(Sec.3097,Civ.C.)
W� Q fender's Name
D Z Lender's Addreu
U 0 1 certify that I tiro Mad this application are su c Nat the above information is
Is, f" cared I agree to comply with all city and county ordinances and some laws misting to
OU building Conswction.and hereby authorim mprventamivs of this City to enter upon the
tmPos
ahovcros,judg d nmdc costs
for e p ensca which m.
H W (We)agree to saw,indemnify and keCP hamlets the City of Cuperono against
fA inc.oacquedgmcnts,caatsandof this esmit. may in anyway vttme against said City
U z A APPLICANT
of Negranting $Nis permit. Date
r. APPLICANT UNDE0.STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIO[JS., , p
fvi ,��s(tor ,/� h�Ya/o 6
_ _ Re-roofs
Signamm of Appli HAZARDOUS MATERIALS DISCLOSURE Dere Type of Roof
Will tie a pulped m forum building c.Chapter
9.1 m handle health anmaterial
As defined io the Cupertino Municipal Codc.Chapter 9.11,and llrc Health and Safety
Code,Stttian zss3z(A)7
❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will Nc applicant or future building occupant use ea Air Qht O Mara which P g
mit hanNous air canuminants u JCOncd by Nc Bay Area Air Quality Management all new materials for inspection.
DisuinT
Qls (:3 No
In
ave mad the has sNssumaurialA requirements under Chepur6.95 of JM Glifar
nial 16,6 SafctyCode,Say.ts M5.25533am125534.1uMceandthnifdc building
des net currently haw•omni.that it is my mspovibility to notify the occupant of the
MquiCmenuwhkhmuvstbe Ipriorm�isspuanccofaCerGBau:offOccapancy. Signature of Applicant Date
Owner or...muzcJaganl ate' All roof coverings to be Class "B"or better