02090033 CITY OFCUPERTINOr : �' ith,��ri'zt
BUILDING DIVISION PERMIT CONTRACTOR INF0Wt "'AT�IQN. '
BUILDING ADDRESS: TAI WONG CONSTRUCTIONPERMIT NO.
A11110-0228 N STELLING RD. 02090033
'S NAME: - 20940 STEVENS CREEK BLVD PERMIT ISSUE DATE
JASON LIN & TENG WU 02/25/2003
PHONE: — SANITARY NO. CONTROL NO.
ARCHITEC iENGINEER: - BUILDING PERMITINFO
OEO PwOMB MECH
silseog LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed ander provisions of Chapter 9(tormenting - Job Description
with Section 70(10)of Division 3 of the Businua ate Professions Coda,and my license is
D�D in full fns¢and cffem. DEMO
j{d2 Uw aClass Lia.#' -
nDana Contractor
ARCHITECTS DECLARATION
I understand my plam.hall On used u public..,us
3 a Licenced PMfessiansl Q _
OWNER-BUILDER DECLARATION "(^\
ii m 1 hereby affirm that 1 am exempt from the Contractota License Law for the G
p o following mean.(Soman 703 1.5,Business and Profe.Wons Code:Any city as county
$ which,equlma a permit to emmruet,ala,,ImpMw,demnlhh,or repair any structaro \
F Sac prior M its ieuuee,alto requires the applicant for such permit to file a signed statement -
gg that he is licensed pursuant to the provisions ofthe Contractor's IJLvnw Law(Chapter 9 Sq.Ft.Floor Area ion
S (commencing with Section 7001)of Division 3 nfthe Business and Professions Code)or
.. that he is exempt mvefrom and the basis for the alleged esempllon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant M a civil penalty of
.at ream than It.hundred dollars(ssw). r Occupancy Type
❑1.u owner of this property,m my employees with wages As their mle compensation,
will do the work,and the net..hoot intended or offered for male(Sec.7044,Beninese NO ASSIGNED T]bTPP '�PTQNP
and PMfassions Code:The Conuactur's License Law docs not apply to as owner of Required Inspections
propeny who wlldjorimmOea thereon.andwho donvuchwok himself.,tormgh his
Own employes,provided that men improvements;ate not Inanded muifered for ash:.If. -
however,the building or Improvement is aid within am year of compledon,the owner.
builder wig have the burden of pmving that he did out build or Improve fur purpose of
sem.).
1.as owner of the property,am exclusively contracting with licensed contractors to
construct Ile project(See.7044.Business and Profusions Code:)The Conuactm's Ll.
cense Law data not apply M an Omer of property who builds or improve themon,and
who contracts for such projects with a contrKtor(s)licensed pursuant M me Contractor's -
License Law. -
uempt under ,B"C ru thlaonf
DAM 6J
—W RIE COMPENSATION DECLA TION
1 hereby allism and r ally of perjury am:of Ne followl lar pions:
❑l haw and will maintain a Certificate of Consent To se161nsuro for Workers Compere
an0on,u provided for by Section 3700 of the Labor Cade.for the performance of the
.it for which this permit is issead.
❑I haw and will maintain Worker's Compematlon Insurance,u required by Section
3700 of the labor code,for the performance of the were for which this permit Is issued. -
My Workers Compensation Insurance carrier and Policy number Are:
Cartier. Policy No.:
CERTIFICATE OF EREMPnON FROM WORKERS'
COMPENSATION INSURANCE -
(This nation need not be completed Ifthe permit Is forum hundreddollm(SIM)
.r Ian)
1 cenify thst l rrmomma of the work for which this permit Is Issued,l Nall not ,
empluyany pc nm any manncranKMbecame mbjectm the Wurkcr'Compensa0an
Lawa.(Cslifo I
WApp al
CE TO A PLC .If,after making this Certificate or Exemption,you should
become mhjcn M the rker's Compensation provisions of the Labor Code,you must
.,O faMwtth comply wW hprovisions a,Nis permit shall he decencd mwtrd.
�► CONSTRUCTION LENDING AGENCY
[+ I hereby Affirm that dare is a mnstsuctim lendinpgency for the performanm of
11'
thin mark ark for which this permit h Broad(Sec.3097,Civ.C.)
14 Q LaMar.Name
0z Lenders Add.
U Q 1 certify dust I have rod this application and tum that the show Information Is
V. F correct 1 agree M comply with all city and county ordinances and state laws meeting to
0U building construction,and hereby mthorlot representatives of this city to crier upon The
W Above-mendoned pMptny for impecth.n puq ALSOL
6, (We)agree to an.
indemnify ad keep hamless the City of Cuycrtlno against
r.v cn Ilabllitiu,judgments.costs and expenses which may in any way secret against said City
U 7 In consequence of me flooding of this pcxnlL -
0;71�T�
a APPLICANT UNDERSTANDS AND WILL COMPLY WIT I4 L yON-POIKf Issued by:qjtQ� Date
SOU ERFD ONS. - ✓v
d3 Re-roofs
nstumor AppI an .onuctor too
RDOUS MATERIALS DISCLOSURE Type Of Roof
Wllltheappli lofutumwilding uccupantstomur Nvu
ndlehardomaadal
ed by the Cupertino Municipal Code.Chapter 9.13,and Be Health ad Safely
'[tion 25532( .)7 u All roofs shall be inspected prior to any roofing material being installed.
Will the applicant.Or fulaM wilding occupant an rgalpmem or device,which -If a roof is installed without first obtaining an inspection,I agree to remove
emit hsvardnus air contaminants as deMcd by the Ray Area Air Quality Management
Dlalrict7 all new materials for inspection. '
- -
❑Yes Nu
I hew road the haamOs materials mquimmenu under Chapter 6.95 of the Califor. '
nia Health a Safely Cade,Section 25505.25533 and 25534.1 understand that irthe wilding
data not currently haw a ananL that it is my responsibility M taItify the occupant of the
Mquimmen muRbemetpriormissuamofaCenifium "racy, Signature of Applicant Date
s All roof coverings to be Class"B"or better
Owner tar thudm g[nl pact coverg