05100077 CITY OF CUPERTINO
BUILDING DIVISION PERMIT kCOP.�IT, RACTOR"'I,N1VF�ORMACI01V
BUILDING ADDRESS: JENNY LIANG & SHENG J. YON ERMITND05100077
I Q078 SANTA CLARA A17
OWNER'S NAME: PERMIT MUE DATE
JENNY LIANG & SHENG J. YON
!E:
SANITARY NO. CONTROL NO,
ARCHTTECr/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
:oo LICENSED CONTRACTOR'S DECLARATION Job DOSCTI IIOn
mF 1 hereby affirm that 1 sm li¢nsed under environs,of CMpte,9(mnnume ng ® p
EZ d wiNSation]0 U)afDi tlon3afdeHu nyaldPafesduuCode,aMmyliceu u 1 Q p acw x.-..-
+« in arsoCI .m err« DEMOLISH H'grFX�tlIS�TfINIXG'�BU,ILDING - SINGLE-STORY
j i Licenser Class Lic.x ° kI G
,Fa
Data Cmdol,lor
e ARCHITECTS DECLARATION
`2 I understand my plans shall he urd as public records DEC Z3
y 2005
e C� Licenced Professional
3 OWNER-BUILDER DECLARATION � ��
COO hereby aiFnn o n 1 a1. Bumps from Net Cation nos L A nen Law far the
O o following..an.(Section 703 1.5,Business and Pm.dco m Cade:Any city or county
yyyyy�,yay�,
<m which rt9uines a pctmit m construct,alar.imPmw.dcmnlW,nr repair any swnum y a; �,n $3000
^zy prior N is issuance.aim rtquims ter applicant for such permit to file a signed saement
< that he is licensed pursuant to the provisions of the Contractors Ucros,law(Carrier 9 $q. F[. Floor tea Valuation
Eel--G (commencing with Section]000)of Division 3 of to Business and Professions Code)or
y Nat he is exempt therefrom and to basis for the alleged exemption.My violation of
Section 7031.5 by any appliam for a permit subjects Ne applicant to a civil penalty of -�WF104i(Alberij UOccupancy e
hent mom Nan Aft hundred dollars($$DD). P y�p
I.n m=of Ne psoputy,m my employeca with wages u Nek nk campenndon,
void Pr hna mk.Cosine
swucmmis uor's LMedc ow damraakls«.]ars Badness Required Inspections
aria Prty,who bis Cade The Canaan/,Llama Ina don ret apply lf an routes of q p
pmpcaywhobuilda0ded Bud s ch imps andwbo aeessuchwdek erodrfOr Brought bh
owne (.the Wiprovidedtataeroimpememmtsart em ear ded of esel
for eche H.
Wilder will
the building or hnpmwmmn I,sold within one year of mmpkdf r the ore of
builder wiB haw Ne brwdut Of proving Nal k did not bend m improv for purpose of
ukJ.
1.u awns of de iumpeny,aro eaddrovaly conmacting win Bccescd mnwucmrs N s
construct the pmjen(Sec.7014,Business and Professions Cade:)The ConmanaYs U.
cense law does ore apply to an owner of psopenywho Wilda or impmvn Nneon,and
who cossets for such projects with a eon scuers)licenced par ud to the Comatemes
License Law.
l notexempt under See ,B&PC for Nis
rn
�' �—
Owner �S Das
"WORKER'S-COMP 1fif001 DECLARATION
rF—
I hembY Orion under Family of perjury one of the following docaratione
1 have and will maintain aecu0am of consent to self-insure farworicescomport.
union,as provided for by Section 3810 of Net Labor Code,fm On No...of use
Omits for which this permit is sawed.
❑1 have and will maionsm Woftes Compensation Insurance,as required by Section
37d0 of to labor Code,for the performance or de,work for which Nin parent is issued. '
My Workces CMPe "Inmrsnn auric and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(]hhsenlon used not xec mpheed f to permit Is Bureau hundred dollars(SIM)
or less)
I cenifv Nat in Net performance of the wart for which this permit is issued.l shall Out
employ any person in any manaer.so as N become subject to the Workers'Compenadon
Law s of Califami DeaA a
Applicant F-}--��
NOTICE TO APPLICANT:Ifaver m ng Nu Certificate of Exemption.you should
became subject N the Wartcfs Compensation provisions of the labor Code,you mean
.J O foMwidt comply with such pmvWou or Nu Permit mail be demand revoked.
Z CONSTRUCTION LENDING AGENCY
1 hereby aline,Nat Nem is a construction knding n acy for Ne perfannarce of
Z' > 0er wort for when On prsmir h issues lSm.309'1,civ.C)
L21 p Latrines Name
4' Laraine,Aaamss
UQ I coldly Nat 1 haw mad this appliation and sum Nn Net•bow information u
m m
gL com1 agree comply with ill city and county aNinueres and sea laws upon
m
0O building mnsuuctionand hereby auNonserepmsmuuves of this city to cow vpnn tM
LU above-mcnlduma Property cut for inspection purposes
6, (We)agree to aver,indemnify and kap hmnkss to City of Cupertino against
to incoisegjnce of th he Zoo sea expcnmxwhich may Many way acemc vgaiulsaid Gey
C)z APPL CANTeUNDERSTANDS Athis
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
�— --z= 7`Y' Re-roofs
Signature of Appliantcon thim
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant or futrec Wilding oraupant wore c haMle nauNous mamriai
m defined by to Copenied Municipal Code.Chapkr 9:12,atb she Health and Safety,
Code.Section 25532(a)?kit ID4 All roofs shall be inspected prior to any roofing material being installed.
will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hanrdnus ate cenuminanis defined by the Bay Arta Air Quality Managcmcm all new materials for inspection.
District]
❑Yes Nu
1 have mad Ne board—meed-In requirements umkr Obeper 6.95 or the c difon
nia Health&Safety CoM,Sections 25505.15533 and 25534.1 undersand On,ifthe building
dors not cuncral,have a snot,Nat it u my mance ihility m motif y On occupant of de
requirements which must be met poor N issuance ora Certifies f
-�_ '99 iu
ex Signature of Applicant Date
OwneronuNariss agent bate '
All roof coverings to be Class"B"or better