05090050 CITY OF CUPERTINOe� . '-'" �
BUILDING DIVISION PERMIT Nl ' NTRACTOR INFORMATION
BUILDING ADDRESS: NICE & RIGHT CONSTRUCTION PF3tl"IT N005090050
OWNER'S NAME: 1.PIMMIT ISSUE DATE
LUI MUK WAI & SO YUET LIN 10663 01/17/2006
NE: SANITARY NO, CONTROL NO.
(408) 861-0928
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(_7 0
in LICENSEDOatIam CONTRACTOR'S DECLARATION Job Description
u F Seems herby affirm IASL I am licensed under pmNvons of Chapxr 9 my he,.i is p
`f wiNllto=and
Sof NC Businev and Profcssium Codc,entl myliccnac is
-t2=e in Toll torte and cnect DEMO (E) HOUSE
License Class Lica
he Date Contractor
MAUL)f{a' //}a�� gNf
ARCHITECTS DECLARATION ��I]V`1f /I'H [I �
C-1 1 unMrstand my plans atoll be used as public records tot�\kf��(��j®'ftp
1.u tf
k C�; Licensed Professional
j`ms OWNER-BUILDER DECLARATION n 4 _ aaoOra
<I I hereby affirm that 1 am exempt from she Convector's Licenx Law for the FSDI �a L o
COO following mason.(section 7031.5.Business and professions Code:Any city or county °'
which requires a permit to convect,alter,improve,demolish,or repair any structure _ ,5 O Q O
LZ<
prior it)its issuance,also requires the applicant for such permit ro file a signed statement — �" "—' "aIh t _
x Nat he isferrtxdparwanttothe provisions ofthe Contrector'sLicense aw(Chapter 9 Sq.Ft,Floor Area 11ay��77 �1sr�Valtiot;6h
xh$ (commencing with Section 7000)of Division 3 of the Business;and Professions Code)or �f7�f1 /f Yin KN
e 5 heal he is exempt therefrom and the basis fm the alleged exemption.Any violation of [[[1111 IL�J/ [7 IJ V
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than rive hundred dollars(I500). r Occupancy Type
Q 1,u owner of the pmpeny,m my employms wish wages u their sole compensation,
will do the wotk end Ne awnure u not intended m oRemA for sale(Sec.7014,Business
and Professions Code:The Contractors Littre Law dors not apply to an owmr or Required Inspections
property who builds orimprows thereon,and whodaes suchwark himself or through his
own employces,provided shat such improvements am not intended oronered forsale.If,
however.the building or improvement is sold within ane yeu of compkuon,the owner-
builder will haw the burden of proving that he did not build or improve for putpmx of
sate.).
Q 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7014.Business and Profusions Cade:)The Contrxmri Li
mnse Law docs not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a conlrxtor(s)licensed pursuant to the Contractors
License taw.
❑I am exempt under sec. ,B&PC[ this n
net Date
ER COMPE A N DECLARATION
1 hereby af01m( der penalty of p furry one of the following daluniorm
Q Ihsm and will mainuin aCcrtifimxaf Coventtoself-insure for Workch Compcm
cation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Q 1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Libor Cade,fm on performance of the work for which this permit is Now.
My Workers Compensation Insurance mina and Policy number art:
Carer: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section mad not hecomplemd if the permit is for one hundred dollars(SIM)
or hexa))
1 certify Out in the Performance of the work for which this permit Is issued,I shill nor
employ,any person In any in rXl :oro 'object b the'Wrifers'limarriantion
Laws of California.Data
Appticam
NOTICE TO APPLICANT: .off aging Nis nifcare of Exemption,you should
become subject to the Worker's Com ensation prov�i of the Labor Code,you most
.J ,Z forthwith mmply with such prov''i s m this pant shall bo dmmetl invoked.
z O CONSTRUCTION LENDING AGENCY
[-+ l hereby affirm that then is a construction lending agency for the performance of
C' the work fur which this permit is wood(Sec.3097,Civ.C.)
f2]Q Lender's Name
D'
Z lender's Address
7
C)Q 1 certify that 1 have mad this application and state Nat theand
above iws totatiun is
0 comm 1 qme to comply with ill city and county oNii es Of and sum laws relating ne
Q U building construction.and herebyauthon purposes,resentatiws of Nu city tocnter upon Nr.
yabove-majudg W propcny for inspection which
(We)agree to saw,indemnify and keep harmless the City or Cupertino against
h in
griming
dof this esmit. may in anyway same against said City
t.) 2 in eonsegmnec of the granting of Nis permit.
APPLICA ERS T N S AN WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EGU ATION . )
6
�- Re-roofs
Signature of App i nummr ate
AZARDOUSM AIS DISCLOSURE Type of Roof
Will dta spin team or future buil ceupant nom m haMle huarduua matcrim
a defined by the Cupertino Municipa
we
Chapxr 412.and Ne Health and Safety
_lQde,section 25532(8
pYes
E3 No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dovima which If a roof is installed without first obtaining an inspection,I agree to remove
emit W7Amdws air contaminants an,defined by Ne Bay Area Air Quality Management all new materials for inspection.
District?
QYcs QNu
1 have mad the hanrdom materials requirements under Chapter 6.95 of the Cilifor
iia Health&Safetycram,seniors 25505.25533 and 25 34.1 uodcrsmnd that if the huili ing
does nos cure a e meaqqqL N t it my ms minty to notify dm cupant of the
regaireme which astbcrht ssaane r enifcataorCePutney. Signature fifApplicant Date
A7 '
Owner or authorizes ages ata All roof coverings to be Class "B"or better