05090219 CITY OF CUPERTINO g, +a �+ "
BUILDING DIVISION
PER T_ CONTRACTOR INpURMATION
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BUILDING ADDRESS: DAREN SHU PERMIT NO.05090219
10489 SCENIC BLVD
OWNER'S NAME: PERMIT ISSUE DATE
DAREN SHU 09/30/2005
E: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION lob Description
IIIdo
Imroby affirm that I am 11¢nowd under provisions of Chapter 9(Commencing
Section 7000)of Division 3o1'the Business aid Prafeuincs Code,and my Iiave is
n� in full forte and At REVISION-WALL
j n z License Class IJc.0
e Dam Conussmr.
ARCHORIG PERMIT #05010180 IN HOUSE ONLY
5
ARCHITECTS mind DECLARATION
IuntleraunJ my phea shill be das public records NO NEW PERMIT
5�
p Licensed Pmfcasiond
Oat I Am exempt
from
DECLARATION
i 1 hereby.(nem that 11. exempt from the Cenunsi Cc :Any c ty o for the
o O following mason.eored w c,ous.0.Breit land Nofosdo l Cale:Any city of county
$ which myuis issuance.•permit w rtim do, a@r.bnpmw,&mM W.ri mash any avucmre
—Z j, priwmiuensedprmant to the Novisio applicant for such prml'wiccam rile a Law(gned Chapter
< that
commincing Wpmction7 the ofDiviomofNeCanuilJ¢nxlaw(Chepmr9 Sq. Ft. Floor Area Valuation
dust he is Itemwith Section rn And the basis n 3Im the
the Business dexempt Prolconson.Anyovi lat&)w $0
S�3 Out he m eampl therefrom and the buil far the Jlcged exemption.Any violation of
Section 7031.5 by Any applicant for a permit subjects the applicant to A civil penalty of APN Number Occupancy Type
not mom than Ow hundred dollars
❑Luowneroftiieproperty,ermyemployecs with waguudmhaalecampensadon,
willdothewark..nddmrwctumiswtinmtdedmartemd(oraam(Sec.7W.Bu nese Re Ulred Inspections
And Professions Code:The Contractor's Liana Law does ret apply to an owner of q p
Property who builds wireposes themon,andwho docse.hwwk him el(w Waugh his
own employ=,provided that such Improvements w not intended"offered fortak.If.
however,the building or improvement is sold within one year of completion,Its ewar-
bell&r .will have she burden of proving that M did not build or impress,for purpose of
0 1.1,as owner of the property,am exclusively canuaming with licensed cpnuanmra to
cooshuct the pmjem(Seo. .Basincsa and Pmfessiaro Code:)The Quarantines Lt.
arae Irw dots not appl to ower of P Y who bull&or impow thereon.and,
who conmcu feesuch wiIns eon m q Zramol puraeant to the Contractor's
License Iaw. /
❑lam uempt un .BkPCfar this mason
Owner Data J; 3D oC
WORK '9OM SATION DECLARATION
I re efliun under penally f perjuryarm of Om following declarations:
❑Ihs dw111 mAinWnaCeNficomaf Cmumttosel(-huucforWmker'sCompen-
satien,as provided for by Section 3700 of the Inbar Code,or du performance of Ne
.,it for which this pormit is issued.
❑I Mw And will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the work few which this permit is issued.
My Worker.Compensation Insorana carrier and Policy number are:
Carver: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisseetimncednot bac tpto dif thepermltI foraec Immemddellara(5100)
or less)
I certify that in the prform of the worts for which t a Pe tit a iauod.I shall nm
employ any person in any nor An utobeco esobje to Worken'Fompem.don
Laws of California.Dal
AnPlicam
NOTICE 70 NT:If,after making this C I am of Exemption,you should
become subject Worker.Compensation prov s of the Lahnr Code,you mum
.J O romwith camp m such provisions w this perm hall be decreed revoked.
Z� CONSTRUCTION LENDING AGENCY
[-+ Ihereby affirm that them Is a consuattitm lending agency for the performance of
a> the woh for which this permit is Wood(Sec.3097,Co.C.)
QUndoes Name ,
a z Lenders Address
Y)Q 1 eerily that 1 haw meed this application and sum that the Above Information is
ly!' correct.l.gra w comply with all city and county ordinances and state lave relating to
Q rU^ building construction,and hereby authorix representatives of this city to cnmr upon me
W &how-mentiwrcd p ,y far nape on purposes
G (We)agree saw.Indemnify and keep featmkss the City of Cuprtine against
In Ifide idu,judgme ,ensu ando.== hmayln anywaysceruc.gaiost WO City
V 7 In consequence o m9 granting of Nis i
Fl APPLICANT ERSTANDS AN W L COMPLY WITH ALL NON-POINT Issued by: Dated`-
SOURCER ATIONS.
Re-roofs X7 f�lie
Sign Lir Applfcan Conusomr ave
HA2ARDOU ATERIALS DISCLOSURE Type of Roof
Il W applicant or future building oaup.nutone a handle haralloos material
As N by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
c ,Sectia.25532(A)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu ❑Nu
win the applicant or future building occupant use equiior t or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
north horardnus.1,contaminants u&fjncd by the Bay Area Air Quality Management all new materials for inspection.
District? 11)
Wdt .nfly
ONO
lmhvsodcxu n Isrequiremenuun&rC9upterli.95oftMGlifor.
cedc.seni .25533 and2553/.lundcramndllwume building
how.mean the t h my responsibility w notify the occupant of W
muubc t rtuias Cora ocnllkemoroccupancy. Signature of Applicant Date
ev All roof coverings to be Class"B"or better
Ow r Lir awhorized AP I Dam